COVID-19 FAQ #4: What are some of the treatment modifications myeloma patients should consider?

The fourth episode of his ten episode COVID-19 FAQ series, Dr. Brian G.M. Durie discusses various treatment adjustments myeloma patients can consider to reduce the risk of infection.  

There are several treatment adjustments that can be made to reduce the risk of infection. Consult treatment modifications carefully with your doctor. 

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Videos in the COVID-19 Series


This “Ask Dr. Durie” is one of the frequently asked questions with regard to the COVID-19 infection. This is frequently asked question number four. And, many patients have very specific questions about possible changes in their medications right now that might improve safety or be helpful.  
One of them relates to the use of dexamethasone, which is a steroid and medicine which can mask the onset of fever. It can also increase the risks associated with infection. And so, there is a broad recommendation which is to discuss dexamethasone with your doctor and see if possibly the dosage can be reduced or maybe dexamethasone could be stopped for a couple of months to reduce that kind of a risk.  
With regard to other medications in general, it seems that the medications you take are not a particular risk related to the COVID-19 infection. However, they can become a risk if the dosages become too high or are producing low blood counts. So, something to discuss carefully with your doctor is if your blood count, particularly your white blood cell count is dropping low with your medicines each month, consider reducing the dose or schedule. For example, with Revlimid, one simple thing to do during this period of time, is to take the Revlimid for two weeks instead of three weeks, just reducing the risk of low blood counts and giving you some extra recovery time.  
And so, you can see that there are a number of these simple adjustments that can be made. Another type of adjustment is to consider a “by mouth” version of a drug versus an intravenous or a shot approach. And so, for example, proteasome inhibitors are Velcade, Kyprolis, and Ninlaro, which is by mouth. These are all proteasome inhibitors. At this point in time, it could be a safe option to consider the Ninlaro, which is an oral proteasome inhibitor and substitute this for a couple of months or so. And, this will reduce the number of visits to the office, the need for blood count checks and the like. And so, this can be a helpful switch at this moment in time.  
The BOTTOM LINE with regard to the adjustments is please follow up with your doctor, use telemedicine, telephone, email, and set plans so that both you and your doctor are happy with the planning which will allow you to keep your myeloma under control, but protect you from the risks of low blood counts and protect you from the risks of having to go in too frequently to the clinic and certainly to avoid going in to the hospital if at all possible. 


Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.


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