Myeloma & COVID-19: What you need to know
by Mackenzie Gignac
COVID-19 remains to be a concern for everyone, especially those diagnosed with blood cancers. We spoke with Associate Professor Hang Quach who is a specialist in treating Multiple Myeloma to gain a greater understanding of the COVID-19 risks and measures that should be taken into account for anyone diagnosed with Myeloma.
How does COVID-19 affect people with blood cancers including multiple myeloma?
Having a blood cancer including myeloma does not necessarily change the risk or way in which a person catches COVID-19. However, having blood cancer does affect one’s immune system. Due to a weaker immune system, a person with blood cancer might have more severe symptoms and may be at a higher risk of ending up in intensive care if they catch COVID-19.
A/Prof Quach says that the best way to minimise the risk of COVID-19 for patients with multiple myeloma is through preventative measures and optimising general health and immune status through effective control of myeloma itself. This include:
- Following social distancing guidelines
- Proper cough & sneezing etiquette
- Frequently washing your hands and avoid touching your face
- Regular exercise and eating healthy
- Some people with myeloma have low antibody levels and if this results in recurrent infection, infusions of antibodies harvested from blood donors (called immunoglobulins) are sometimes given every month to boost the immunity in general. We do not know whether or not this will specifically reduce the risk associated with COVID-19. People who are already receiving immunoglobulin by venous injections in the hospital can ask their haematologist if they can have it continued at home as an injection through the skin.
- In people with myeloma that is progressing, one of the best ways to optimise the immune system is effective control of myeloma.
Will myeloma treatment increase the risk of contracting COVID-19?
‘In patients with active myeloma, the best defence against any infection, including COVID-19, is to effectively treat the myeloma itself,' says A/Prof Quach.
‘For patients with active myeloma, we need to offer the best treatment possible,' says A/Prof Quach. ‘However, how this is done will depend on the stage of the pandemic we are in and if there are sufficient hospital resources to deliver the type of treatment we need.’
I am due for Autologous Stem Cell Transplant (ASCT) should I proceed?
Autologous stem cell transplant (ASCT) remains an important part of initial treatment for fit patients who are diagnosed with myeloma. ‘It improves progression-free survival compared to a non-ASCT approach,’ says A/Prof Quach.
The decision to proceed or delay ASCT during the COVID-19 pandemic varies between different hospitals and is usually determined on a case-by-case basis. ‘It depends on the inpatient capacity of that hospital at the time of the pandemic. We don’t want to put a patient through a stem cell transplant when intensive care beds cannot be accessed if it is needed during the peak of the pandemic,’ says A/Prof Quach.
A/Prof Quach mentions that patients can remain on Bortezomib based therapy while awaiting for autologous stem cell transplant if this has to be delayed.
With Australia’s preliminary success in reducing the number of new COVID-19 cases, the expected peak of the pandemic is pushed out for some months. Some hospitals have therefore chosen to continue autologous cell transplants. ‘At St. Vincent's Hospital in Melbourne, we feel that there is a window, at this point, to offer autologous stem cell transplants to patients who are at higher risk before the peak of the pandemic occurs,’ says A/Prof Quach.
Can maintenance therapy continue after autologous stem cell transplant during the COVID-19 pandemic?
Maintenance therapy after stem cell transplant remains important because it has been shown to improve progression-free survival and overall survival compared to no maintenance, for people with myeloma. The usual maintenance therapy is with a drug called Revlimid (also known as lenalidomide)
‘Revlimid is not considered to be an immune suppressive drug. Given the fact it can be taken as a capsule by mouth at home, most haematologist will elect to continue maintenance therapy,’ mentions A/Prof Quach.
What about bone-strengthening treatment with Zometa or Pamidronate?
Bisphosphonate therapy (Zometa and Pamidronate) remains an important part of supportive care in minimising the risk of bone fracture and optimising bone health. A/Prof Quach says that some recent data has shown that bisphosphonate therapy every three months may be just as effective as monthly therapy, which has changed how they administer this treatment at her hospital.
‘At St. Vincents we have elected to lengthen the frequency of bisphosphonate therapy to every three months during the COVID-19 pandemic, and will deliver this through the hospital in the home to minimise the number of patients coming into the hospital.’
What is the important information for Myeloma patients to know right now?
Relative to the rest of the world, Australia is in a good position. ‘We have managed to flatten the curve,’ says A/Prof Quach. She says this has allowed hospitals to preserve their inpatient capacity and resources to continue to offer appropriate treatments for patients with blood cancer including multiple myeloma.
‘Non-urgent therapies for multiple myeloma has to now be reconsidered,’ says A/Prof Quach. However, as the situation of the COVID-19 pandemic is still evolving, patient treatments should still be considered case-by-case, taking into consideration hospital capacity and the risk to patients if certain myeloma treatments were to be omitted or delayed for a prolonged period of time says A/Prof Quach.
A/Prof Quach says that patients that were previously denied treatment due to COVID-19 can now start to ask their haematologists to re-evaluate their position to see if treatment can restart. ‘If a patient has been instructed to not have treatment it would be worth asking your doctor again regarding their treatment plan.’
Lastly, A/Prof Quach recommends that patients keep in regular contact with their doctor for treatment plans as the COVID-19 situation is constantly evolving.