How are you managing care delivery during the COVID-19 pandemic?

We are trying to utilize telemedicine as appropriate to reduce the need for patients to come to the clinic. Where possible, we have converted treatment to all oral regimens and modified the schedules of the IV or SC drugs to enable less frequent administrations. However, we recognize that altering the dose or schedule can negatively impact the outcomes. When it can be safely done, we have reduced the frequency of blood tests, both for toxicity management and for disease assessment, to enable safe and effective ongoing therapy. Stem cell transplantation, where it can be delayed, will be delayed until after the current situation improves. Increasing use of video visits will allow better assessment of ongoing issues, especially any toxicity related to treatments. We are using mail-in labs or labs at nearby facilities where possible.

What education instruction are you providing to your patients with multiple myeloma who are already immunocompromised and are you continuing treatment as planned?

Standard infectious disease prophylaxis measures are being more strictly adhered to. Patients are urged to follow current guidelines regarding physical (social) distancing, hand washing, face masking, etc. If they have new symptoms, they should contact their health care providers.

In this setting of the COVID-19 pandemic, will clinical trials continue to enroll patients?

Clinical trial accruals are continuing, but changes vary from institution to institution. Generally, trials which have the potential to provide therapeutic benefit are continuing where allowed. Oral therapies are being shipped to patients, and toxicity assessments, where possible, are being done via telemedicine. Blood tests are being performed using mail-in kits where feasible.

Are there certain agents which could be selected for treatment which may lessen immunosuppression?

There is no information regarding the effect of specific drugs on the risks of acquiring the SARS-CoV-2 virus infection. At this time, the anti-cancer treatment combinations chosen are those which are likely to be most effective, while minimizing the need to visit any healthcare facility.

More information is available on the website for the American Society of Hematology (www.hematology.org).