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The Multiple Myeloma (MM) Hub is pleased to share this article, prepared by Elena Zamagni, Paola Tacchetti, and Michele Cavo, “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, IT, discussing impact of COVID-19 on the management of patients with MM. The MM Hub extends its gratitude to the authors for taking the time to prepare this guidance, based on their experiences in Bologna.
COVID-19 suddenly fell on patients with MM, planting questions, fear and uncertainty, bringing a sense of loneliness and abandonment, increasing the need for reassurance and perspective. The virus also reached all the doctors and caregivers of the hematology departments, bringing stress, fatigue, new questions, and the need to re-organize their work priorities. It also raised uncertainties about the effectiveness of their work. Whilst patients with MM are afraid of the coronavirus, they are mainly afraid of not being able to proceed with their treatment and worry that any potential hold or modification of initial treatment plans will impair their outcome. Patients wish to stay safe and virus-free and are asking themselves if going to the hospital is dangerous, but at the same time they wish to speak to their doctors, to be able to tell them about the side effects of their treatment, to receive necessary drugs, and to speak about future plans. Mainly, supportive services, like psychological support and voluntary activities for patients are on hold and people are lacking the relational approach that is so important when you are weak, frail, and ill. At the same time, doctors and nurses need, and wish, to stay safe, and keep departments as free of SARS-CoV-2 as possible. In this regard, it must be highlighted that, probably, each hematology department will experience two phases with the spread of the infection:
Living this new, astonishing, and somehow surreal reality for one month now in Italy, we are able to share some thoughts, that are not formal recommendations, but the experience of our team in Bologna.
The outpatient unit is often the “first line” for patients. It is the unit with more people, in different disease phases, different severity and urgency, with more movement, and the highest grade of heterogeneity. Nowadays MM is mainly treated and managed within this setting. As previously said, there is the need for the safety of both patients and caregivers, to reduce the circulation of people and access to the hospital as much as possible, and to keep secure distances within our environments. At the same time, it is important to preserve compliance to treatments and ensure follow-up are safe.
These actions may help in the management of this new challenge:
The inpatient unit must be kept totally, or as much as possible, COVID-free, both for the patients and the caregivers. This is of course linked to the need to proceed with the treatments that cannot be postponed, in order to not impair their outcome or to put patients at risk of relapse, while at the same time considering these patients have the highest infection risk. As far as MM is concerned, as previously said, most of the treatments are offered in an outpatient setting, apart from allogeneic transplantation (less and less present in the actual MM scenario), chimeric antigen receptor (CAR) T-cell programs, and in most, even though not all institutions, autologous stem cell transplantation (ASCT). The goal in this context is to respect already-started, necessary programs, reducing as much as possible the risk of potential additional complications, while deferring or changing plans where possible, in order to keep beds free in the unit for other diseases, such as acute leukemias, which have a more strict and urgent treatment need. We believe that these actions might be appropriate:
In such a difficult moment, is important that all the MM team stay united and calm, able to re-discuss previous choices in light of emerging new elements, re-allocate patients and care-givers to different tasks, and remain available to offer staff members to help the growing COVID-19 units in our hospitals. With the increased spread of the virus, the hospitals, and in particular the caregivers, are at higher risk of infection, despite sometimes being asymptomatic, and thus responsible for further transmissions. For this reason, it would be very important to ask to local administrations for serial pharyngeal swab on doctors and nurses; however, this is unfortunately at conflict with available resources in most countries.
In conclusion, we would like to acknowledge that, for most of us, this is the first time that we are facing such a complex scenario, with different and conflicting needs, with urgent and essential restrictions to be put in place, while keeping an eye to the “after” that will hopefully be behind the door. We really feel, in this moment more than ever, that caregivers and patients are fighting together to overcome this pandemic, but it is important to overcome fear, loneliness, and sense of abandonment, and to go back to hope.
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