Continuing his COVID-19 FAQ series, Dr. Brian G.M. Durie discusses if myeloma patients should undergo autologous stem cell transplant (ASCT) and stem cell harvesting during the global health crisis.

BOTTOM LINE:
It is recommended to delay ASCT and stem cell harvesting. If possible, continue your induction therapy for a few months. Consult with your doctor to discover what will work best for you.

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IMF Chairman Brian G.M. Durie, MD welcomes your questions about the latest myeloma treatments, research, controversies and quality of life issues. If you have a question you think might be of interest to the myeloma community, please send to [email protected]!

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Videos in the COVID-19 Series

• FAQ #1: How can myeloma pts reduce the possibility of being exposed to the coronavirus?
• FAQ #2: What do myeloma patients need to know about COVID-19?
• FAQ #3: Do myeloma patients need to adjust their treatment?
• FAQ #4: What are some of the treatment modifications myeloma patients should consider?
• FAQ #5: What are the risk factors that could lead myeloma patients to develop serious consequences from the COVID-19 infection?
• FAQ #6: What precautions should myeloma patients take when getting their groceries?
• FAQ #7: Is it safe for myeloma patients to take walks?
• FAQ #8: Is physical distancing still recommended for myeloma patients?
• FAQ #9: Can myeloma patients avoid contracting the COVID-19 infection?
• FAQ #10: Should Myeloma patients undergo routine COVID-19 antibody testing?
• FAQ #11: Are MGUS and smoldering multiple myeloma (SMM) patients considered to be at higher risk for severe consequences from a COVID-19 infection?
• FAQ #12: If a myeloma patient takes Revlimid® (lenalidomide) as maintenance treatment, should this patient continue with that treatment during the pandemic?
• FAQ #13: Is it safe for myeloma patients to resume in-person doctors' visits?
• FAQ #14: Should myeloma patients undergo ASCT during the pandemic?
• FAQ #15: Is dexamethasone helpful against the COVID-19 infection?
• FAQ #16: Is it safe for myeloma patients to travel by airplane?
• FAQ #17: How high of a risk do asymptomatic carriers pose to myeloma patients?
• FAQ #18: Is Ninlaro® a safe treatment alternative for myeloma patients during the pandemic?

Transcript:

This “Ask Dr. Durie” is about a very important and sensitive topic, especially during this time of the COVID-19 crisis. And, the question is: “Should I go ahead with autologous stem cell transplant (ASCT)?”  

And, the answer to that is probably not right at the moment until the healthcare system is in better shape and recovering from the impact of dealing with so many individuals so seriously infected with the COVID-19 infection. And so, in general, the recommendation from most myeloma experts right now is to delay autologous stem cell transplantation.   

And, this mostly means that you would delay either the harvesting, and/or the transplant. And, this is because the hospitals are really stretched in terms of resources, and personnel, and protective equipment, and the like. And, it’s not a good time to be doing these extra types of procedures. And, as you could imagine, it’s not an ideal time for you to be in the hospital and, potentially, being exposed to the COVID-19 infection.

And so, broadly speaking, it really is a good idea to delay autologous stem cell transplant. Now, there are some issues related to that. And, the question is: “Okay, if I’m going to delay my autologous stem cell transplant, what am I going to do in the meantime?  

And so, clearly this is something that needs to be reviewed carefully with your doctor. Normally, it’s fairly easy to continue with the initial therapy that you’re taking, what we call the induction therapy, and give one, two, or three more cycles while you are waiting for things to calm down, where it will be safe for you to get back into the hospital setting. 

Now, I would say that across the United States, there are some cities and regions where the COVID-19 infection is actually under pretty good control. And, I’m aware of several centers where they have been continuing to do a limited number of harvesting and transplants. So, it is very important to review this.    

And so, the BOTTOM LINE is probably it’s wise to delay your autologous stem cell transplant, which can be done safely. It’s okay to continue with that front-line induction therapy for a few more months. But, do talk to your doctor and see whether it might be safe and feasible for you, but, probably not, and organize what will be the best ongoing treatment for you in this interim period.

Dr. 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®.