Clinical Features and Risk Stratification of Multiple Myeloma Patients with COVID-19

Abstract

SARS-CoV-2 infection often results in a more severe COVID-19 disease course in multiple myeloma (MM) patients compared to immunocompetent individuals. The aim of this report is to summarize the clinical features of the MM patients with COVID-19 and the impact of MM treatment on outcomes to guide risk stratification and ensure the appropriate management of the patients. Serological responses in MM patients post-infection or -vaccination are also reviewed to better understand the strategy of prevention. Along with reports from the literature, we presented findings from a retrospective analysis of the clinical characteristics and outcomes of COVID-19 infection in MM patients in our institution. Study population includes 34 MM patients with a median age of 61 (range: 35–82 years) who tested positive for SARS-CoV-2 between 1 March 2020–15 August 2021. We examined the effect of chemotherapy, the benefit of neutralizing monoclonal antibody (Bamlanivimab) and the impact of anti-CD38 antibody (daratumumab) on the hospitalization and mortality of the patients, as well as the efficacy of native antibody production. Our results showed that MM patients have increased hospitalization and mortality rates from COVID-19 compared with that of general population, especially those on active chemotherapy. Advanced age, high-risk myeloma, renal disease, and suboptimal disease control are independent predictors of adverse outcomes. The use of daratumumab does not increase the disease severity/hospitalization or the post-infection/vaccination seropositivity of SARS-CoV-2. The neutralizing antibody decreases overall mortality. Evidence from the current study and previous publications suggest that testing of neutralizing antibody post-SARS-CoV-2 vaccination in MM patients may be needed in reducing COVID-19 risk.

Breakthrough Infections in SARS-CoV-2-Vaccinated Multiple Myeloma Patients Improve Cross-Protection against Omicron Variants

“…In addition to current expert consensus statements in the post-pandemic COVID-19 aera [32,33], our results provide data elucidating the effects of BTIs and help in the guidance of MM patient management. The strength of our study is that we longitudinally evaluated vaccine responses in an MM cohort according to different treatment groups and at different stages of immune competence.…”

Managing and treating COVID-19 in patients with hematological malignancies: a narrative review and expert insights

“…The impact of anticancer treatments on COVID-19 outcomes in MM patients has been inconclusive. While some studies showed no negative outcomes and robust immune responses in MM patients receiving anticancer treatments [ 58 , 61 , 62 ], others indicated a higher risk of severe COVID-19 symptoms with active MM therapy [ 63 , 64 ]. Findings on the anti-CD38 antibody daratumumab in relation to COVID-19 severity and complications have been mixed [ 61 , 64 ].…”

“…While some studies showed no negative outcomes and robust immune responses in MM patients receiving anticancer treatments [ 58 , 61 , 62 ], others indicated a higher risk of severe COVID-19 symptoms with active MM therapy [ 63 , 64 ]. Findings on the anti-CD38 antibody daratumumab in relation to COVID-19 severity and complications have been mixed [ 61 , 64 ]. Proteasome inhibitors and corticosteroids have been associated with an increased risk of severe COVID-19 outcomes, including ICU admissions and mechanical ventilation [ 45 , 65 , 66 ].…”