A 75-Year-Old Woman With Multiple Myeloma - Episode 5

The Impact of COVID-19 on Treating Patients With Multiple Myeloma

December 22, 2020
Saad Z. Usmani, MD

Saad Usmani, MD, reflects on the impact the coronavirus pandemic has had on his practice and the treatment of patients with multiple myeloma overall.

Saad Usmani, MD: The coronavirus pandemic has certainly impacted our clinical workflow as well as the way that we conduct patient care. Virtual visits and virtual medicine have made strong inroads into how we are managing patients. It’s going to be here to stay, even after the pandemic is over. We are also trying to see how we can streamline operations in the clinic so that patients have shorter exposures to the health care setting.

During the surge of the pandemic, we were modifying the patients’ regimens and trying to give them less frequent exposure to the infusion centers. Even in the absence of data, we had to do it for safety reasons. Then the subcutaneous formulation of daratumumab came along and made things a little easier for us because it reduces the period patients have to stay in the infusion center to receive daratumumab.

Subcutaneous formulation of daratumumab has improved the clinical workflow as well as patient satisfaction without impacting the efficacy of the drug. Our centers have gone to the subcutaneous formulation altogether, and we expect that most of our patients will be switching over to the subcutaneous formulation of daratumumab.

Transcript edited for clarity.


Case: A 75-Year-Old Woman With Multiple Myeloma

Initial Presentation

  • An active 75-year-old woman presented with new onset back pain and a 10-month history of fatigue, mild sensory neuropathy
  • PMH: hypercholesterolemia, diabetes, and atrial fibrillation; all medically controlled
  • PE: bony tenderness appreciated on the hips and lower back


Clinical Workup

  • Labs: Hb 10.2 g/dL, calcium 11.1 mg/dL, LDH 186 U/L, creatinine 1.3 mg/dL, albumin 3.7 g/dL, beta-2 microgloblulin 3.6 mcg/mL, potassium 1100 g/dL, M-protein 2.6 g/dL, lambda free light chains 4.1 mg/dL
  • Hepatitis B and C negative
  • X-ray showed L4 vertebral compression fracture
  • Skeletal survey showed multiple lytic lesions in femur
  • Bone marrow shows 40% clonal plasma cells IgG k with hyperdiploidy FISH
  • Diagnosis: R-ISS stage II MM
  • ECOG 1

Treatment

  • Patient is ineligible for ASCT due to comorbidities
  • Initiated treatment with daratumumab + lenalidomide + dexamethasone