COVID-19 infections and clinical outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers
M Hultcrantz, J Richter, CA Rosenbaum, D Patel… - Blood cancer …, 2020 - AACR
Blood cancer discovery, 2020•AACR
Patients with multiple myeloma have a compromised immune system, due to both the
disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-
19. Here, we report outcomes and risk factors for serious disease in patients with multiple
myeloma treated at five large academic centers in New York City in the spring of 2020,
during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with
multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; …
disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-
19. Here, we report outcomes and risk factors for serious disease in patients with multiple
myeloma treated at five large academic centers in New York City in the spring of 2020,
during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with
multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; …
Abstract
Patients with multiple myeloma have a compromised immune system, due to both the disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in patients with multiple myeloma treated at five large academic centers in New York City in the spring of 2020, during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these, 13 patients (17%) were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 nonadmitted patients, 4 were asymptomatic. There was a higher risk of adverse outcome (intensive care unit admission, mechanical ventilation, or death) in Hispanics/Latinos (n = 21), OR = 4.7 (95% confidence interval, 1.3–16.7), and African American Blacks (n = 33), OR = 3.5 (1.1–11.5), as compared with White patients (n = 36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated (P > 0.05) with adverse outcome: hypertension (n = 56), OR = 2.2 (0.9–5.4); diabetes (n = 18), OR = 0.9 (0.3–2.9); age >65 years (n = 63), OR = 1.8 (0.7–4.6); high-dose melphalan with autologous stem cell transplant <12 months (n = 7), OR = 0.9 (0.2–5.4); and immunoglobulin G <650 mg/dL (n = 42), OR = 0.9 (0.3–2.2). In this largest cohort to date of patients with multiple myeloma and COVID-19, we found the case fatality rate to be 29% among hospitalized patients and that race/ethnicity was the most significant risk factor for adverse outcome.
Significance
Patients with multiple myeloma are immunocompromised, raising the question whether they are at higher risk of severe COVID-19 disease. In this large case series on COVID-19 in patients with multiple myeloma, we report 29% mortality rates among hospitalized patients and identify race/ethnicity as the most significant risk factor for severe outcome.
See related video: https://vimeo.com/486246183/559a80cfae
See related commentary by Munshi and Anderson, p. 218.
This article is highlighted in the In This Issue feature, p. 215
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