Coronavirus (COVID-19) & Multiple Myeloma
Our Chief Medical Officer, Hearn Cho, addresses important questions for multiple myeloma patients
While Coronavirus (COVID-19) continues to dominate news broadcasts around the world, as the MMRF’s Chief Medical Officer, I believe communicating directly with our patients at this time is crucial to keeping you informed and helping ease any stress you may be feeling about this health issue.
There is no vaccine currently available to prevent Coronavirus. The MMRF highly recommends that patients with multiple myeloma exercise best hygiene practices and take the necessary precautions to avoid exposure to COVID-19. Please see our COVID-19 FAQ for Multiple Myeloma Patients, below.
How to minimize your risk
- Ensure you have enough food and medicine, both prescription and over-the-counter, for about two weeks. If possible have a family member or other caregiver shop for you. Contact your myeloma physician about obtaining extra necessary medications.
- Wash your hands with soap and water frequently for at least 20 seconds each time.
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
- Avoid touching your nose, eyes, and mouth with your hands.
- Avoid friends, family, and colleagues who appear to be sick.
- Practice social distancing; the Centers for Disease Control and Prevention (CDC) recommend staying at least 6 feet from others while out in public.
- Limit social gatherings; try to avoid any meeting of 10 or more people.
- Wear masks when in crowded areas with poor air circulation.
- Avoid any non-essential travel, especially by commercial airline or cruise ship.
- Avoid travel to any areas where outbreaks are occurring. Check the latest CDC travel info here.
- Check the latest announcements from the WHO here, and the CDC here.
- As always, maintain hydration and exercise periodically; this reduces the risk of blood clots.
- If you develop a fever, seek medical attention, preferably from your myeloma doctor.
- If you are coughing or sneezing, contain the spread of germs by coughing/sneezing into the crook of your elbow or a tissue instead of your hand. Dispose of the tissue promptly.
- And, because it is still flu season, please strongly consider getting a flu shot.
Multiple Myeloma Transplant and Cellular Therapy:
The American Society for Transplantation and Cellular Therapy (ASTCT), the leading medical organization on transplant, has issued interim guidelines for COVID-19 management in transplant, and two of the leading US transplant centers, the Mayo Clinic in Rochester, Minnesota and The Fred Hutchinson Comprehensive Cancer Center in Seattle, Washington, have issued recommendations that they are instituting at their sites. These are slightly different, but overall they provide useful guidance in this matter.
If you are in remission and the stem cell harvest and transplant were schedule for consolidation therapy, we recommend you have a discussion with your doctor about delaying both until the immediate crisis has passed. If you have already begun the stem cell mobilization process (chemotherapy and/or growth factors), you should discuss with your doctor whether to proceed with the harvest or not; you should still discuss delaying the transplant procedure even if you get your stem cells harvested. Your doctor may recommend going back on outpatient chemotherapy while you wait for the right opportunity to proceed with harvest/transplant.
If your doctor recommended auto-transplant for the treatment of relapsed disease, you should have a discussion with her/him as to whether you should proceed or not. There may be alternative therapies available, but if your doctor feels that auto-transplant is the best option, you should weigh the risks and benefits of proceeding at this time versus delaying.
We encourage you to have these discussions with your myeloma treatment team as soon as possible. They know you best, and they may have decided on their own guidelines for managing transplant during this crisis.
Multiple Myeloma and the Immune System:
It is not known if people with smoldering myeloma have completely normal immunity or if it is impaired as in active myeloma. It is likely that the majority of smoldering myeloma patients are somewhere between the two extremes. We strongly recommend every individual follow social distancing and good hygiene practices. At this time, there are no specific additional recommendations. If you do develop any of the common symptoms of COVID-19 infection, including fever, cough, body aches, fatigue, and shortness of breath, you should call your doctor right away.
If you are participating in a clinical trial for smoldering myeloma, you should speak with your doctor for instructions on continuing, delaying, or stopping therapy.
At this time, there is no credible evidence that IVIg has any impact, positive or negative, on COVID-19 infection. You should speak with your myeloma treatment team to decide if you should continue or delay IVIg treatment until the immediate crisis has passed.
Medications and COVID-19:
At this time, clinical trials for anti-viral drugs such as remdesivir and anti-malarial drugs chloroquine and hydroxychloroquine are underway to determine if these are effective against COVID-19. Remdesivir is an experimental drug (not approved by the FDA) originally developed for the Ebola virus and it is not commercially available. Chloroquine and hydroxychloroquine have potential for serious side effects, especially on the heart, and should not be taken without a doctor’s prescription and supervision. The HIV drug Kaletra was tested in a clinical trial in China and was found to have no effect on severe COVID-19 infection. Finally, there are plans for clinical testing of the blood pressure drug losartan based on its potential effect on the way the virus enters and infects cells. However, there is no scientific evidence that any of these medications can prevent COVID-19 infection or can be used to treat the infection at home, so you should not take any of them without consulting your myeloma treatment team. It is likely they will advise you against taking them.
This does not apply to myeloma patients because you should not take NSAIDs anyway because of increased risk for kidney failure. This class includes ibuprofen (Motrin), naproxen (Aleve) and other over-the-counter medications. You have probably already been instructed to take acetaminophen (Tylenol) for fever or pain, and narcotic medications for moderate-severe pain. The COVID-19 crisis does not change this recommendation; DO NOT TAKE NSAIDs..
You should speak with your doctor about continuing or stopping steroids such as dexamethasone or prednisone. The World Health Organization (WHO) issued guidelines recommending against steroids for the treatment of severe COVID-19 infection with respiratory distress, but that recommendation was based on findings in a related disease and only applies to patients who are hospitalized for severe illness. Other regulatory agencies such as the FDA and CDC have not issued such recommendations. Steroids are an important part of most myeloma treatments, so you should have a discussion with your myeloma treatment team about the risks and benefits of continuing them.
No. There is no evidence that acyclovir or valcyclovir have any effect on COVID-19. You should still follow social distancing and good hygiene guidelines.