COVID-19 in the Multiple Myeloma Patient

Saad Z. Usmani, MD, FA:

We have had to adjust to the realities of the COVID-19 pandemic. And I think Sydney, you were based in New York during the pandemic. So a lot of treatment decisions, or the way that we approach treating patients, have to be modified in the urban setting. Can you provide us some comments on that?

Sydney Lu, MD, PHD:

Of course. So I think looking back the myeloma group and the transplant group here jointly decided that for the majority of our transplant eligible patients who would otherwise have undergone a transplant, that they would have stem cell collection, but actually have their transplant deferred. Especially at the peak of the COVID pandemic. And that’s of course, since resolved. But otherwise I think a lot of physicians have tried to move away from regimens that require a lot of clinic, or infusion suite visits whenever possible.

Saad Z. Usmani, MD, FA:

What about you Shaji, what has your experience been as you were thinking about treating patients? Where you favoring more oral regimens and less frequent monitoring, maybe relying more on virtual medicine?

Shaji Kumar, MD:

Yeah. It certainly accelerated the whole concept of virtual medicine, for sure. But I think as Sydney already pointed out, we deferred none of the transplants, especially in patients under good disease control, where we could continue with the injection therapy for some time.

Shaji Kumar, MD:

Patients who were already scheduled to be collected their cells, and that did not receive your transplant right away. We did convert to oral therapy wherever possible, especially in patients who are on stable disease, on maintenance phase, but people with active disease, we continued with the therapy with the understanding that maybe controlling the disease is very most important at that point in time.

Shaji Kumar, MD:

And then we certainly tried to do a lot more virtual visits, and then patients going into nearby clinics to do the blood work so that they can avoid the travel and that they would send us either the results, or else we would send them a kit for them to send the blood back to the lab for us to do the blood work.

Shaji Kumar, MD:

So a lot of changes that were made with the goal of don’t compromise on therapy, make sure that we can reduce the patient’s travel and then make sure we still adequately monitor them.

Saad Z. Usmani, MD, FA:

So, Amrita, will some of these things be retained in the post and pandemic management of myeloma?

Amrita Krishnan, MD, FA:

So, certainly what Shaji alluded to in regards to telehealth. I think that is here to stay, and I agree, especially California. Look at the size of the state, it’s really saved many of our patients hours of travel for routine follow up visits, for example.

Amrita Krishnan, MD, FA:

Obviously there’re certain patients who need to come on site, but patients, as Shaji said, are on oral regimens, you’re following blood counts, monitoring side effects can be done by telehealth. I think the one thing I hope is not here to stay, is I hope I get to see you in person sometime soon, Saad, instead of on Zoom. But I think telehealth certainly has been very helpful.

Saad Z. Usmani, MD, FA:

I completely agree with you. I think we have gone through this phase of becoming totally virtual and very conservative in managing patients during the pandemic, and now are recognizing that there were a lot of positives that we learned through that experience that we’d like to retain. But I agree, Amrita, I would love to see all of you live again sooner than later, and have this engagement in-person.