The Myeloma Crowd Round Table Interactive Webcast was held on May 16, 2020. Session One covered issues for newly diagnosed patients and featured three myeloma experts:
Dr. Natalie Callander, MD, University of Wisconsin School of Medicine and Public Health in Madison
Dr. Luciano Costa, MD, PhD, University of Alabama at Birmingham
Dr. Binod Dhakal, MD, MS, Medical College of Wisconsin
COVID-19 Issues for Myeloma Patients
Drs. Callander, Costa, and Dhakal discuss their experiences with treating myeloma patients during the COVID-19 pandemic.
Myeloma Diagnosis and Staging
Dr. Callander explains how a myeloma diagnosis is confirmed, MGUS and smoldering myeloma (SMM), and how to understand and interpret myeloma lab results.
Dr. Costa provides an overview of initial treatment strategies, explains induction, consolidation and maintenance, and what types of supportive care are used in myeloma treatment.
Stem Cell Transplant
Dr. Dhakal explains stem cell transplant eligiblity, the differences between autologous, allogeneic and tandem transplants, and if transplants are still needed in an era of many new drug approvals.
Expert Panel Questions & Answers
0:32 When a patient is first diagnosed, does the specialist typically already know if this patient will be a candidate for transplant or do they have to wait and see how they will respond to the first line of therapy before deciding?
4:55 Does having a MGUS diagnosis mean the immune system is more at risk and what are doctors looking at in the lab work?
6:35 We’re told that we are in an immunocompromised category. How exactly do we measure our immune system? To put it another way, exactly which blood tests and myeloma markers can we monitor to know just how immunocompromised we are?
10:18 How do you identify non-secretory myeloma and how do you track it?
11:53 We had some questions about daratumumab use, especially in the COVID scenario. If you are not taking it now should you start it, in relevance to COVID? And if you’re on it, is there any additional risk?
15:09 [Re: a patient’s whose stem cell transplant procedure was suspended due to pandemic. No detectible disease at the moment, on Revlimid, Velcade, dexamethasone (RVd).] What do you suggest for these types of patients, since you are still doing stem cell transplants, especially with respect to the immune system post-transplant, not just the transplant process?
16:33 [Re: patient who had a collapsed vertebra, has been on therapy for two months with probably Kyprolis, Revlimid, dexamethasone (KRd).] Is that the right therapy since he’s had a collapsed vertebra?
18:39 We have two questions about causes of myeloma. Is exposure to heavy metal when young a cause? Or exposure to Agent Orange?
20:56 [Re: newly diagnosed patient, age 52, had bone breaks that led to discovery of disease.] What is staging in myeloma and how it is not similar in staging other types of cancers? How should she weigh the benefits and risks of treatment options? Can chemotherapy prevent more broken bones and bone pain?
24:53 [Re: being newly diagnosed and now on Ninlaro and dexamethasone maintenance.] How long should she stay on maintenance? How should it be managed?
26:46 [Re: patient with low neutrophil and white blood cell counts, wants to boost it, has lowered Revlimid dosage.] What are the causes of low immunity with stable disease?
29:24 What are the best ways to improve physical fitness during and after treatment? Is weight training beneficial or dangerous?
33:00 What is early vs. delayed stem cell transplant? If you had a moderate response to your first transplant, should you get a second one, and at what time? If I’ve collected enough for two stem cell transplants, when should a second transplant be considered?
37:43 [Re comment: patient who had six month remission after transplant, but is in 17th year post-diagnosis, so patients can still good outcomes.] Are allogeneic transplants a possible cure?
42:30 [Re: patient diagnosed with MGUS at age 54, symptomatic stage 1 myeloma at 69, on Revlimid, Velcade, dexamethasone (RVd), mother was diagnosed with non-secretory myeloma at age 82 and died within 22 months.] Based on family history, would you recommend an oncology consult and screening for siblings and children? What about other family members if one is diagnosed with myeloma?
Greg Brozeit has been with the HealthTree Foundation since 2015 when he began volunteering for the Myeloma Crowd. Prior to that he worked with Dr. Bart Barlogie and the International Myeloma Foundation, inaugurating many myeloma patient advocacy and education programs.