A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

Abstract

Background: The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the United States. Our institution has treated over 2,000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York. Methods: We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020 and April 30, 2020. We report epidemiological, clinical and laboratory characteristics including persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes. Results: Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-white. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%) and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (>70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly (p<0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant (p<0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-white race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. Median time to PCR negativity was 43 (range 19-68) days from initial positive PCR. Conclusions: Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality. Mounting a severe inflammatory response to SARS-CoV-2 and severe hypogammaglobulinemia were associated with higher mortality. The majority of patients mounted an antibody response to SARS-CoV-2. These findings pave a path to identification of vulnerable MM patients who need early intervention to improve outcome in future outbreaks of COVID-19.

Clinical characteristics and outcome of multiple myeloma patients with concomitant COVID-19 at Comprehensive Cancer Centers in Germany

“…Remarkable from our data was the death rate of 0%, whilst MM disease features and characteristics were similar to those of real-life UK-and US-MM-cohorts with different health systems. 12,16 Albeit the median patient age in both UK-and US-cohorts was older than ours and both had more non-whites than typical for Germany, lines of prior therapy, ASCT-rates, median number of comorbidities and ALC/immunoparesis frequencies were comparable, suggesting that with maximum triage support and supportive care, MM/cancer patients per se may not have a dismal Covid-19 infection outcome. 2,3,[8][9][10] Early data in cancer patients in general 5,17,18 have suggested higher risks in those with systemic/chemotherapeutic treatment within 4 weeks before symptom onset, male gender, and poor constitution, whereas our experience in 39 cancer patients with Covid-19 infection compared with very well matched non-cancer controls suggests no difference in OS for both groups (K. Shoumariyeh et al, manuscript submitted).…”

“…[2][3][4][5][6][7] Other risk factors associated with adverse outcome seem to be nearly the same as for non-cancerpatients: advanced age, male gender, presence of substantial comorbidities (neurological: advanced Alzheimer, Parkinson, cardiovascular disease, diabetes mellitus, respiratory disease, chronic kidney disease, liver disease and immunosuppression). 11,12 In this German multiple myeloma (MM) study group consortium (DSMM and GMMG), we aimed to characterize a population of MM patients registered from 10 institutions who developed Covid-19 at hotspot areas of Germany. All MM patients with concomitant SARS-CoV-2 infection were treated at secondary and tertiary Comprehensive Cancer Centers (CCCs).…”

“…The features of these patients were comparable to others, except that our patients were younger. 12,16 We have previously discribed that younger MM patients may come to German tertiary centers, albeit "stage and age migration" is occurring, 19,20 since elderly and frail patients have recognized the advantages of university centers/CCCs' support offers. Moreover, since all regional German hospitals were enthusiastically dealing with Covid-19 patients, we were not the only centers, where Covid-19 patients were treated, which may be different to other more centralized medical systems.…”

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

“…A few studies showed that individuals with obesity may decrease in‐hospital mortality 31,75,87,89 . Some studies showed that obesity may insignificantly decrease 41,47,81,90 or increase 55,67,68,84,91–96 the odds of death among individuals with obesity. The majority of studies showed that obesity significantly increased the odds of death among COVID‐19 patients with obesity.…”

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

“…To our knowledge, this is the rst large-scale case series describing the epidemiology and outcome of COVID-19 in patients with hematologic malignancies. To date, only small case series in this setting have been reported (14,15,21,22) in mainly hospitalized patients, whereas our study included both inpatients and outpatients. Our ndings show that patients with hematologic malignancies and COVID-19 have 3-4-fold higher rates of severe/critical disease (62% vs 15%) and mortality (33% vs 10%) compared to COVID-19 cases in the general population.…”