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

FAQ Library published on May 20, 2020
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Sagar Lonial, MD, FACP
Chair and Professor
Department of Hematology and Medical Oncology
Chief Medical Officer
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia

Welcome to Managing Myeloma, I have recently been asked, “Are there certain agents which can be selected for treatment which may lessen immunosuppression?” I think it is important to realize that immunosuppression in the context of myeloma therapy is a balance. And what I mean by that is that there is nothing more immunosuppressive than active and progressive myeloma, and so while you may need to use some level of immunosuppression with IMiDs, proteasome inhibitors, steroids, or antibodies; the benefit of that in terms of re-establishing normal immunity are better than allowing myeloma to march unimpeded and continue to suppress the body even more so. And so again, we think about using lower-dose dexamethasone approaches, trying to go lower with intensity of intravenous medications, going to daratumumab perhaps once a month instead of once a week in the right settings, and trying again to minimize the risk that patients take by continuing to shelter in place and reduce exposure to COVID-19 through their family, through their friends and through their community.

Last modified: May 19, 2020