Thread by @VincentRK

If you have questions on myeloma treatment in light of #COVID & need help, I am going to try

For general questions: Reply to this tweet

For personal treatment questions: DM me —be brief

#myelomaVR #mmsm @mtmdphd @NorthTxMSG @MyelomaTeacher @grpetersen1 @IMFjimMYELOMA

Thread

Clearly the best person to help is your own doctor. I’ll try and answer— at least give a general guidance based on risk/benefit judgment.

Any myeloma colleagues willing to help out with this thread, please chime in and give your input also. @SagarLonialMD @szusmani @myelomaMD

One of the most common questions we are getting is on transplant. As I previously noted We recommend DELAYING the transplant process (including collection, & storage) for all newly diagnosed patients until the corona epidemic is over #COVID

If myeloma patients are already in the process of collecting stem cells, go ahead and collect, but delay the transplant especially for standard risk patients. If any insurance company gives problems let us know. We need to document this.

In order for people not having to go through the entire thread. I’ll keep adding important answers at the beginning to my thread.

2/ Question: Should we stop Revlimid maintenance to lower risk of COVID?
Answer: Dont stop maintenance. Relapse of myeloma is riskier than Revlimid

Here is the #COVID resource page from @IMFmyeloma @BrianDurieMD myeloma.org/covid19-myelom…

Here are 4 recommendions for the French intergroup, the IFM, that was conveyed to me by Dr. Philippe Moreau, and many leaders of the IMWG electronically met and agree with. @BrianDurieMD @myelomaMD #mmsm

Here are Top 10 questions on COVID and myeloma that @BrianDurieMD @IMFmyeloma has addressed. 1/5

Top 10 COVID questions for myeloma patients. @BrianDurieMD answers. 2/5

Top 10 COVID questions for myeloma patients. @BrianDurieMD answers. 3/5

Top 10 COVID questions for myeloma patients. @BrianDurieMD answers. 4/5

Top 10 COVID questions for myeloma patients. @BrianDurieMD answers. 5/5

3/ Question: Will delaying collection & giving multiple cycles of VRd compromise ability to collect cells later?

Answer: Risk is low with plerixafor. Risk of exposing patients to COVID during collection is far more than risk of not being able to collect. Delay collection for now

4/ Question: Best frontline treatment in these times?

Answer: VRd x 8. Len maintenance (for most patients). If high risk Len plus bortezomib (lower dose than initial VRd). @NorthTxMSG @mtmdphd

5/Question: Response is slow and doctors don’t want to go to transplant because of COVID. What to do?

Answer: Slow and steady wins the race. A slow response does not mean that the disease is bad. Risk of transplant is high. So continue on treatment that’s working.

6/Question: Will IVIG help against COVID

Answer: No

7/ Question: If I get COVID should I hold Revlimid (or other myeloma therapy).

Answer: My colleagues and I feel we have no data but that a short interruption till one recovers from COVID seems prudent. No data.

8/ Question: Do I need monthly Zometa?

Answer: No. please let’s do Zometa every 3-4 months. I was not convinced of the need for monthly before. And I’m even more convinced of that now in light of the COVID situation.