(Guest Lecture): COVID-19 Issues for Myeloma Patients | Experts Discuss Relapsed/Refractory Myeloma, Amyloidosis

you [Music] I think with our new panel we may want to go ahead right no I Paul oh guys new and all we really just wanted to since we've got some new people on board in different perspectives we wanted to start out with a short discussion on myeloma and kovat and the experiences that you've had at your facilities and some of the insights that you'd like to share with our patients so with that I would invite any of you to start maybe dr. Zander if you could start and then we could go to dr. Shaw and dr. Hari and then Jenny will follow up with a few questions mm-hmm so this has obviously been a source of great concern and attention for clinicians and for patients right now it's led to major disruptions across medical systems all across the country and really around the world the you know we myeloma patients as a as a group because of their need for ongoing treatment in their you know often immunocompromised State it has been a challenge this is a patient put there some data that suggests this may be a particularly susceptible patient population and you know we get a lot of questions from patients about first susceptibility to the infection but also outcomes once they're diagnosed with kovat and the data is not complete with regards to either of these points but there is a little bit of data to suggest that myeloma patients you know face challenges in both regards we we've definitely seen kovat infections you know amongst our clinic patients I have to say that our experience so far is I don't think very different than the general population in terms of the spectrum of what we're seeing ranging from asymptomatic patients who are diagnosed after they were exposed to somebody who had a diagnosis ranging all the way to fatal kovat infections with all the respiratory complications that we've seen so it's you know it is it's hard to draw conclusions from the the snapshot of patients that you know any one Center sees even even at the largest centers in New York and New Jersey you know meaning the centers that see that have seen the most kovat cases even those programs you're talking about a few dozen cases of kovat in myeloma patients no no Center has hundreds of myeloma patients that have that covered yet and so right now there's a large scale right there's a is an interest in in a national or international collaboration to try and understand the scope of the problem in myeloma patients and to echo Geoff's statement it is a really interesting time and I think a lot of it for a lot of us a little bit of anxiety because we're not sure as physicians and patients what's going to happen but I will say that I've been encouraged so far because I think that our mental patients are already educated to be careful about their context and about being clean and washing hands and all the things that we kind of hammer in all during the myeloma journey and I think that's helped our patients and I will say just from our own experience in San Francisco understanding that our prevalence is probably a little bit different for example in New York City in our group of four myeloma specialists we've only had I think one person to our knowledge who had em Gus and was just being treated in the community who is tested positive for kovetz so we don't have that many people who have tested positive for kovat and I'm not sure if that's because we're not testing them or because they haven't been symptomatic to require a test but this does give me a little bit of encouragement to pursue treatment for myeloma for the patients that need it because we know that getting kovat is a possibility but we know that needing treatment is a definitive thing that that for sure has to be taken care of so I've been a little bit more I've had a little more courage to recommend treatment and starting treatment and continuing treatment in the myeloma community for my patients thanks Jenny and Greg and thanks chef pnina for inviting me so what have I learned from Kuwait so in the previous session my colleague dr. the call was there and he might have already mentioned this if I'm hearing please you know forgive me so we had those two temptations but after the first seven patients or so dr. the colonist we decided to write up this and we just got published in leukemia on our own experience so here are my lessons and I will give you some take-home points for the attendees so our findings were that Bielema patients definitely seem to be getting Kovac at a higher rate just from the low levels of cases seen in Wisconsin in general we bagged patients with myeloma who seem to be getting it at a slightly higher rate and that just goes consistent with doctor's order said I lead at myeloma patients have a disease that is immunosuppressive at the outset and some of our treatments also make patients immunosuppressed so number one take-home point is that be very very very careful our modern toolset is not helping Kovach patients just yet so the old tool set up quarantine stave a social distancing use a mask use sanitizer that myeloma patients have to definitely abide by those rules as much as possible the second interesting finding that we had is that none of our patients had been anywhere near a hospital in the step in the three to four week period prior to them getting diagnosed with Kovac suggesting that all of this transmission happened outside of the hospital and they were more likely to contact contracted in the community than in a hospital third thing most hospitals are actually have that really good preventive in fact in our Hospital among the cancer patients we just had one patient who was unexpectedly positive where we think it was a testing that was at Port rather than the in know being suspected ingested the patient's negative we had to retest a couple more times before we got a positive so do you think the transmission happening within the healthcare environment is very minimal and hospitals have taken and have done a good way of preventing it therefore I would echo what Nina said ie that if your myeloma needs treatment and if that is the risk to you myeloma is the risk to you it is probably safe to go to a good hospital and get your treatment the furthering treatment just because of the fear of Kovac may actually cost more damage than myeloma on the other hand if your myeloma is in a very very long remission and if you just donate in a statement you're not visiting the hospital that much might be a good time to take a holiday and see what happens and and that you know we advise that some patients to but if you are in need of treatment please don't defer treatment that's my place thank you and have you seen that I guess that that begs a question for the three because you've had all three different experiences have you seen patients who have delayed or move to oral options or things like that who are now maybe that wasn't such a good idea or what's been your experience what's too short to tell you know because you know so I really like this at this point that how are you saying that this is the time to make me think of some things that might be more user-friendly for the patient and you know we we understood we always talk about myeloma being you know a marathon a disease and the patients have to do so much and this is a good time to think about switching a little bit and I like the fact that we have oral regimens out there this is a huge deal and this does mean sometimes our patients can do remote visits many times actually and we have labs from local quest and and you know there's really no reason for them to drive three hours and I really think this is if there's any silver lining me out it's gonna be work better at remote medicine I still feel connected to my patients especially because I can see them it's kind of funny because I can see their houses and they can see my office so I kind of like that so oral chemotherapy with local labs and remote monitoring it's actually becoming a new thing yeah well I agree with that I have a lot of patients who for the last several years have been traveling a long way to come see us downtown and I have a feeling after this experience we're gonna be seeing a lot of them by telemedicine going forward because they've realized you can accomplish 90% of what you do by getting local labs and talking like this the you know I think it's it what I think the point of one's getting at is it's it's always a question of competing risk and active myeloma in terms of life-threatening problems as far as being a life-threatening problem or being a health issue that has real potential consequences in terms of kidney function or skeletal complications you know when it's active the risk of undertreating that probably outweighs the risk of kovat or you know their the impact that therapy for myeloma will have on your kovat risk and you know I I agree that oral regimens have been a godsend and this time but it's also important to remember that in the studies that have compared you know ongoing therapy versus fixed duration therapy although there there is consistently a difference favoring continued therapy it's also important to remember that very few patients who stopped therapy progress within the first month or two of stopping and so you know when there is a major health crisis like this sometimes you know it's the most reasonable course of action is actually just to skip them on to therapy and then resume it when able when it's safer both of those points and I think what we are all saying is that risk is your own risk is personal and it's a risk versus benefit calculation in which you need to arrive at with your doctor and see if there is from myeloma and the need for treatment is high enough to warrant coming to the hospital and thankfully most hospitals have taken excellent precautions so that in hospitals practice minimal at this point great I'm gonna ask one more code related question and then we'll start our panels and then we'll do Q&A at the end but for those who didn't attend the first session I asked this also of the other panel who are you seeing of myeloma patients who are at most high risk for koban infections and are they similar to the patients that are being seen across the broad community the diabetics the people who are struggling with hypertension or obesity or end-stage renal failure which does include a lot of myeloma patients right or kidney issues is it that or is it something else I mean just you know as was discussed in the earlier session myeloma patients have up there's a lot of different components to the immuno compromised that myeloma patients have we we know from the broader kovat literature that coexisting conditions you know definitely seem to put patients at higher risk as far as blood counts lymphopenia which is low low lymphocyte count may may predispose to infection but also may predispose to a worse course during infection and many myeloma patients you know have low lymphocyte counts but again and then I'm curious to know what the others will say I mean right now unfortunately the myeloma data is a little bit incomplete you know and we don't I think being able to identify you know beyond beyond myeloma patients who have the risk factors that we we think we know about for the general population it's not entirely clear to me that you can identify a specific subset of myeloma patients otherwise this morning more data I mean we don't really have that much experience like I said we don't have that many patients so I think it's more about your general health right now than it is necessarily just about myeloma of course that is your just change your baseline risk something that my little patients have been worried about especially when they get on these journeys okay what can I do what can I how can I make this journey better and a lot of them try to walk and do all the things that we talked about prepping for transplant and I think those things have actually helped some of our myeloma patients gain control of their global health and that will probably help them god forbid if if they get infected with this virus that that's my feeling I don't have data to back that up mm-hmm dr. Hart you have any comments same thing we need far more data but the risk is twofold one is the risk of getting my getting call it if you're my loved one I probably agree with everyone that it is higher of contracting that and the second is getting really bad Kovac when you get duplicate I have had an 82 year old gentleman who got bit long years of myeloma got Kovac successfully went home and I had a 36 year old lady who actually passed away from a heart attack that happened after the Kovac so both ways it has gone both ways it's just we just don't know what is driving this infection can be really mad yeah well everyone joined the study we can learn more about this because we will be doing more follow up of people who because we have very few people in a study I think under five or so that I've tested positive for coping with myeloma in the study and we'll be asking it repeat timepoints over the next probably year you know did you end up having a positive kovin infection and then we'll be able to tell from there because I think just the antibody test you're not not telling us really if they however haven't so far so that's fantastic so um we do have a QA and people can participants who are watching can add their questions in the Q&A we will have several panel discussions or individual discussions and then we'll go to the Q&A at the very end and I already know we won't be able to answer all the questions but we'll try to do it as much as we can you [Music]