(Guest Lecture): COVID-19 Issues for Myeloma Patients | MCRT Webcast: Experts Discuss Newly Diagnosed Multiple Myeloma Issues

you [Music] so with that I think we'd like to get started by addressing an update on code 19 issues and then I'll ask a couple of questions and then we'll move on to each individual doctrine so maybe we just want to open it up I think my questions my biggest questions are around what's happening in terms of what are you seeing in the clinic with co19 you want to give us broad updates and then maybe I'll have some follow-up questions there's obviously some regional differences in the country about what how many people are coming in with kovat and how serious it's been in the Wisconsin area we have had a relatively low case number but one thing that that did come up again when we were chatting and I've had a personal experience with this with a few patients we are getting a little bit concerned about people who may for example have myeloma have some symptoms that are very scared to come to the hospital we we really hope that as people are starting to see some decline that that is not going to happen but I know of a couple of cases where that really did have a negative impact yeah I think the number of patients that we are seeing you know two months ago and now has come down quite a bit especially last month in March that are in March and April actually the number of patients that we're seeing came down quite a bit but slowly I think it's picking up I can see based on our clinical experience yes last week and a week before now the patients are I think a little bit more comfortable but I still agree that you know the patient's given the fact that you know cancer patients and many myeloma patients are at a higher risk of getting Koval and maybe the outcomes I think there is a fair out there and we have been trying to you know getting more data out I still don't have a lot of data in that setting so we're telling the patients that we are using all the precautions and making sure that they're getting the right treatment and I think one important thing to convey to patients is you know as you should be the case of our business in society healthcare and you know in cancer care for these certainly have match or exceeded what is necessary to be able to safely deliver care so first and foremost talk to your physician talk to your to your to your treatment team and if they tell you it's okay to come to the clinic and and be seen is okay to come and big treatment you really should trust that I think of course the the challenges out there is in society is real but the the hostels have gone above and beyond to create measures to minimize the unnecessary directions and be protective of the staff and be protective of the patients and as we're discussing earlier there's the the risk of one or two extra trips to the clinic to be to receive the treatment that is much needed is not gonna it's not it's going to be much smaller than the risk of neglecting or or delaying treatment for the multiple myeloma it's just like doctor the call we saw a completely disappearance of new cancer diagnosis for a couple of weeks in March just to see now unfortunately patients coming in with with very advanced disease patients who you know in renal failure that you know should have basic care you know two or three weeks before they wouldn't be the way doctor calendar and just as a car leasing some more things in your clinic insurance of patients being more nervous and then how yeah absolutely you know I I really have felt strongly that that there are people who need to be seen in person and we've continued to see people all through this same way with transplants again we've been fortunate to not have very large numbers of kovat 19 patients so we can really for the very small numbers we have put them in one area in our hospital so we've been transplanting right through this because for some people they actually really need to have that done now I don't think every institutions had that luxury that we've had just because of our geography but but I would agree with Luciano that our biggest concern is that we know people still were getting cancer there it's not like it's stopped because of the virus and I think we've all been very concerned about you know among those those deaths that are reported you know how many of those people did have say an undiagnosed malignancy you know perhaps myeloma perhaps leukemia something like that yeah so in our case we didn't do transplant in the month of April we deferred because we had of course it was everything was new and as a program decision we made kind of to defer the the transplant from myeloma so those patients were on the list for transplant they didn't get the transplants we talked to the referring physician to increase you know to increase the cycle of induction so go to one addition cycle or two additional cycle but now we have started the process back on so from this month onwards now because we know more about this and we know the impact a little bit more and we know how to do the the percussions and all those stuff so where we started the process so a lot of our patients are on the line for transplant now having said that there are few patients still kind of concerned and nervous about coming down here because Milwaukee if you look at it the number of cases in Wisconsin is the highest in Milwaukee in the Milwaukee County where our Hospital is so people are kind of you know coming far off from here they are kind of concerned coming here I mean you're worried that if you're coming hotspot maybe their risk of killing and the interaction so that education that we are doing that you know what we are doing to prevent all those so the number of cases getting transplant are increasing now another question that I have for all of you is has there been a better definition amount you have a little more experience with this current situation in your Hospital of who exactly is it considered high risk for developing couvade severe symptoms because in my opinion on the national scale or statewide scale this conversation is not we're not doing a good job and identifying okay here's a here are the vulnerable people let's separate them it's not just elderly it's people with these other comorbidity conditions that scooter couldn't be and then it are my limitations and greater risk or just in those specific with those specific comorbidities that's relative to population so if you look at the evidence I didn't think there is much evidence out there if you know even the fact that a lot of data is coming out from China okay they are the heat of those cases so if you look at the patients with cancer and particularly with the hematological malignancies where myeloma is included very small cohort of the studies are there I mean one from China and then I can couple of from China and in that you know they definitely looked looked at the outcomes of these patients and they found outcomes are severe as compared to the patients who didn't have cancer or other other hematological malignancies so having said that you know there are other risk factors in those patients that could have contributed for example as you say a patient with other commodities like diabetes hypertension you know lung disease so that could have contributed to but but cancer definitely it's up there you know any cancer and myeloma per se we don't have a lot of data based on our own experience we have four four of our patients who have it I mean seven of our patients were to Cove it and you know it's you look that good you know in our cities but we have to look at the largest scale and to see if that really puts them at a higher risk and if there's a very good point dr. Rocca and the other point to make is there's myeloma often overlap with some of the other conditions that are we know our principal about it having bad complications you know being older you know hypertension and diabetes and so forth and you know it's certainly you know also it's important to keep in mind you know I'll not allow patients with myeloma are the same you related their disease and the treatments they're in our one can I guess estimate that the risk of somebody who is seen you know is disease well control on maintenance which Revlimid it's probably not as high as somebody who is you know receiving triple quadruple therapy or somebody who has had multiple lines of therapy and now you know is just receive car t-cell for example so the risk is probably not the same across the spectrum and I think it's going to take a lot more data to to figure that out but the important message is how does as far as we know all those factors contribute to have a negative outcome once your car they don't make it you more propensity to acquire defiers in and I think following you know national and regional guidelines and following the policies of the clinics that the patients are going to they still the likelihood of one acquire Co vid 19 in most places is to quite small so nothing that would justify patients you know getting away from treatment yeah I think I agree our experience you know those patients who had the coven none of them acquired through the to come into the clinic or to the hospital you know so all of them had community acquired you know transmission it's a very important point I mean in the early days of this crisis we we slowed down our transplants as well we never stopped completely and it was really more as a fear of that our whole health care system was be so overwhelmed that we couldn't spare their workforce we couldn't spend a workforce and the hospital acity to take care of those patients unfortunately they never happened you know all hospitals have taken measures to keep kovat patients on a separate unit with proper isolation measure dedicated staff so you know the fact that you're coming and getting transplant on a hospital that has Kovac patient by no means means that your increased risk of being exposed I think the most in most settings I really haven't really heard of reports of cancer patients on cancer hospitals acquiring ku vid in the clinics or or under a hospital setting so I just want to make a couple comments Jenny you know I think you're the study that you're doing is very important because I actually I think the experience is going to vary from patient to patient around the country and there was a publication that came out of modify or very recently looking at outcomes specifically in cancer patients who had coded and and those with hematologic with blood cancers did do worse just as a factor perhaps not surprising you know so I think there's a lot we have to learn and I think as Luciano alluded to there is a lot of opinion out there but boy do we need data you know we need data about prevalence of the virus where is it who's had it you know how many people are going to get it I think for the areas like our part of the world that have been less hit I think that concern now is turning more towards a boomerang effect you know come the fall because very few of our populace look like their antibody pathes antibody positive in other words they might have protection against covet so if there is a big outbreak I think you know we may have sort of gotten off easy if you will right now but I think there is a concern that later in the fall there's going to be a much different situation and that ironically places like New York City in Boston and Chicago and Detroit may actually be in a better situation so I I think Jenni would be very very insightful for the audience to ask and the second half some of these same questions and see what dr. Zander and dr. Shaw I've seen yeah so we had two individuals who had confirmed cases of Ovid and one kind of very bad bad side effects and very serious complications and chip several weeks and one the other was asymptomatic and they both were taking the rapid Animus kits and the one with severe condition have showed very strong IgG line but the other one who is asymptomatic sure nothing so it begs the question if a vaccine is developed for this will patients myeloma patients or on the ground community develop IgG antibodies towards this which I have no idea what you're thinking I think there are a few data I mean again it's on a small scale data but people who are symptomatic and depending the severity of the illness I think the antibody production also has been seen to be correlated with that so people who are asymptomatic they are not mounting very strong antibody response that is in general population again I know the small small kind of observation so we don't know in myeloma it's things a little bit different because they already have this humoral deficiency and you know impaired b-cell responses so with that apply same to myeloma no but there are some data out there that you know to mount a good antibody response you have to some sort of symptoms or some sort of you know the see very less I think you know like for any other vaccine it probably depends a lot where you are and it under myeloma trajectory yes you know ever ever treatment it is good at killing malignant plasma cells is excellent of killing the normal ones that eventually make the antibodies that gave protection so I think it's going to pain very much and what phase of therapy the patients are in but the principle that I think is important to emphasize for any transmissible disease the way vaccines work is you know in part of course the individual protection but also you know what we now the popular rights term herd immunity and the principle you know taking a different disease what I usually tell them but the families that I see you know around the flu season is you know you the patient take the flu shot we don't know if it's gonna you an amount of response or not but everybody in this room and everybody who you know go ahead and take this shot is by protecting them self they also protecting you and I think if we're fortunate to soon have a vaccine for Co V 19 the same principle should apply I think you know there's I mean I think that's an excellent point Luciana because there's been some small studies now that show that myeloma patients in particular who do have evidence of mounting response to their vaccinations they are getting particularly after transplant seemed to do better and so I think you know while we're all focused on the virus I think we don't want to let normal health concerns we do want people vaccinated for pneumococcus and influenza as you mentioned and so you know I know there's been sort of an interruption of a lot of that kind of sort of standard health maintenance for our patients but it's really important that we continue that - okay we have a question and we're going to have a question a very extended Q&A section or later in the program but this one is really relative to kokand and it's from Joanna she's very immunocompromised due to the myeloma and she's taking extreme caution but she's wondering if she's just overreacting by not holding her grandchildren for example and she's been four-inch feeding since October following in pneumonia and sepsis she's been quarantined for seven minutes so is that - extremely I think this is a broad question patients are wondering to what extent do I go give any insights I'll be I'll give it a honest answer that I give to my patients of course you know at a society level social distance is clearly very impactful and is helping contain these epidemics and and use a popular term reflecting the curve and everybody is individually responsible for to contribute to that and I think we all are in our patients more than anybody because they you know they already some of those breakfasts are already very natural to them they have they know you know before there was coffee there were other challenges of the patients fear flu and others they were used to those practice as time goes by and in a weeks turned into months I think it's very important that we balance that against our you know our well being and or you know happiness and so what I tell patients is you know we don't want you to go to a rock and roll concert or be the first person in when the bars open but you know if you have a that that core of people that are very important for your life and they're well they're healthy they're taking precautions in terms of interact with with the broader public you know make that kind of micro society quarantine or or you know self isolated in small clusters of family or people who are meaningful to your life there will definitely help lower the burden of coping with those measures for for a very long period of time and and essentially keep you happy you know keep meaning keep your life meaningful because you know being by it being by yourself at a time of so much uncertainty so much fear when you already facing cancer is is not fair and it's probably necessary I think that you know they increase risk of adding your grandchild in yours your daughter in your you know son-in-law to that little nucleus of people who are kind of isolating together if you will it's probably neglectful and is much more has probably much more benefit than risk well that's a great answer and then dr. calendar you mentioned some of the early day that we're seeing on blood cancer patients as a whole being higher risk and looked like it was Keamy or lymphoma patients not necessarily myeloma patients and many of those were on checkpoint inhibitors who seem to have a worst outcome which myeloma patients are not necessarily on is that something that everyone wants to address you know I think this is again we have a paucity of really good data here about how certain drugs may impact and I'm sure all of the panelists have heard from colleagues you know that it for example a colleague of mine said boy we've seen that people starting initial therapy on same bortezomib lenalidomide index are doing terrible in our part of the country I've not I seen that where we are and again I've heard other colleagues say that boy are patients who have been on let a little my maintenance don't seem to be doing well I just think we have got to get some sort of organized databank going so that we could understand this a little better you know is that everybody getting these drugs is it it doesn't depend on the region is it your age is it as dr. Costa said other cofactors like diabetes or hypertension I think we're all sort of really operating in the dark so I can add on few lines on that so I agree I think if you just look at the data I can recall this - two studies that came out just recently one from friends group they looked at purely hematological cancer patients 25 patients and out of that 10 patients had multiple myeloma and you look at them they were in various stages of treatment and so and their outcomes you know if you look at it not that the best outcome that we want to look at and then the other study came from China or the group of patients out of that only three patients have multiple myeloma they didn't especially look at the outcome described outcome of that patients so we at this point of time we don't know what medications put them at the risk of you know having a bad outcome with the COBIT based on our own experience out of those seven patients I can tell you they were on different histories of treatment some where an induction treatment somewhere on maintenance treatment somewhere relapsed/refractory treatment and the outcomes were independent of that so I think what we need is a you know kind of large scale data and that probably would help us find out what put them at high risk you [Music]