Real‐world assessment of the clinical impact of symptomatic infection with severe acute respiratory syndrome coronavirus (COVID‐19 disease) in patients with multiple myeloma receiving systemic anti‐cancer therapy

Abstract

Real-world assessment of the clinical impact of symptomatic infection with severe acute respiratory syndrome coronavirus (COVID-19 disease) in patients with multiple myeloma receiving systemic anti-cancer therapy Dear Editor, Infection with the novel coronavirus SARS-CoV-2, resulting in an acute respiratory disease (COVID-19), is the cause of the current pneumonia pandemic, with a rapid rise in cases being reported in the European Union and UK. 1,2 The UK index case was identified on January 31, 2020 and, given the rapid spread and high mortality rate of COVID-19, it is imperative to define the impact on patients with co-existing medical conditions. 3 Multiple myeloma (MM), the second-most common haematological malignancy, is a cancer of the mature B-cell lineage, and is associated with both cellular and humoral immune dysfunction that renders patients susceptible to infections, especially of the respiratory tract. [4][5][6][7] This, coupled with a median age at presentation of 70 years in a population with frequent co-existing medical conditions, means the outcomes of MM patients infected with COVID-19 warrants particular attention. We conducted a fully-anonymised prospective clinical audit where only MM patients with documented symptomatic COVID-19, whether managed in the inpatient or outpatient setting, were reported. All patients were tested within the secondary care setting and were receiving systemic anti-cancer therapy (SACT).At the time of analysis (May 18, 2020), 75 completed proformas from MM patients who tested swab-positive for COVID-19 had been received (Table I). The median age of COVID-19-positive MM patients was 73 years (range, 47-88), with 27Á5% of patients >80 years of age. Where ethnicity details were available (n = 51), most (82%) were Caucasian, with 16% being Afro-Caribbean. 41% of patients were newly-diagnosed MM receiving frontline therapy (NDMM); 24% had relapsed from their frontline therapy and were now receiving second-line therapy (1 st REL); and 35% had relapsed and/or refractory disease (RRMM). The median absolute lymphocyte count at presentation with COVID-19 symptoms was 600 cells/ll (range, 0-2500), with 90% of patients demonstrating hypo-gammaglobulinaemia affecting at least 1 sub-class (IgG> IgM>IgA). The male/female ratio was 1Á5, but varied with age (<75 years ratio 2Á33 vs. >75 years ratio 0Á94) as a consequence of significant age difference between the groups (P = 0Á049).The median time from the UK Index case to COVID-19 symptoms was 54 days (range, 23-88). 20Á5% of patients did not have a temperature on presentation but did have a cough, and 16% reported GI symptoms, with 20Á5% of patients acquiring COVID-19 whilst an inpatient for other reasons. 75% had evidence of pulmonary infiltrates primarily detected by chest radiograph. All but three patients were admitted for clinical care. Systemic anticancer therapy (SACT) was stopped a median of 0Á5 days (range, 5-23) after the onset of COVID-19 symptoms. Only nine of 70 patients received critical care support, with five pati...

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).…”

COVID-19 risk for patients undergoing anticancer treatment at the outpatient clinic of the National Cancer Institute of Milan: the COVINT study

“…In our report, we found no significant differences according to cancer type and stage, treatment regimen and line between COVID-positive and COVID-negative population, as in recent reports. 8 10 Given the multiple comorbidities and the anticancer treatments that affected patients were receiving (which included also immunotherapy and endocrine treatments, unlikely to foster COVID-19 worsening), we are convinced that the infection and its outcome were more probably related to the overall frailty of these patients, and were not directly caused by treatment (see table 2 ). In this light, we do believe that the risk of COVID-19 and its complications is higher in the most fragile patients, especially those with advanced, more aggressive cancers.…”

A review on how to do hematology consults during COVID-19 pandemic

“…Hypogammaglobulinemia is a condition with reduced immunoglobulins in the serum, which can be a primary or secondary phenomenon [ 119 ]. The primary antibody deficiency syndromes are extremely rare and hence, malnutrition, plasma cell, or B cell-directed therapy as in patients with myeloma, lymphoma, patients on immunosuppression after a stem cell transplant or after chimeric antigen receptor (CAR) T cells remain the most common causes of hypogammaglobulinemia worldwide [ 120 ].…”