The potential link between Covid‐19 and multiple myeloma: A new saga

Abstract

Background Covid‐19 is considered a primary respiratory disease‐causing viral pneumonia and, in severe cases, leads to acute lung injury and acute respiratory distress syndrome (ARDS). In addition, though, extra‐pulmonary manifestations of Covid‐19 have been shown. Furthermore, severe acute respiratory distress syndrome coronavirus type 2 (SARS‐CoV‐2) infection may coexist with several malignancies, including multiple myeloma (MM). Methods This critical literature review aimed to find the potential association between SARS‐CoV‐2 infection and MM in Covid‐19 patients with underlying MM. Narrative literature and databases search revealed that ARDS is developed in both MM and Covid‐19 due to hypercalcemia and proteasome dysfunction. Results Notably, the expression of angiogenic factors and glutamine deficiency could link Covid‐19 severity and MM in the pathogenesis of cardiovascular complications. MM and Covid‐19 share thrombosis as a typical complication; unlike thrombosis in Covid‐19, which reflects disease severity, thrombosis does not reflect disease severity in MM. In both conditions, thromboprophylaxis is essential to prevent pulmonary thrombosis and other thromboembolic disorders. Moreover, Covid‐19 may exacerbate the development of acute kidney injury and neurological complications in MM patients. Conclusion These findings highlighted that MM patients might be a risk group for Covid‐19 severity due to underlying immunosuppression and most of those patients need specific management in the Covid‐19 era.

Multiple Myeloma Patient with Secondary Liver and Tongue Involvement, Complicated by COVID-19-Induced ARDS: An Autopsy Case Report and Literature Review

“…This is consistent with findings from a series of case reports where, among five MM patients with COVID-19, three individuals died due to progressive hypoxemic respiratory failure and one patient developed ARDS following temporary improvement [54]. ARDS is known to develop secondary to MM itself, characterized by diffuse alveolar infiltration by atypical plasma cells [55]. This is preceded by a gradual increase in respiratory failure due to diffuse alveolar metastatic calcification of the alveolar walls and blood vessels, accumulation of alveolar paraproteins, and amyloidosis of alveolar septa [56].…”

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

“…It has been recently reported that the expression of angiogenic factors and glutamine deficiency could link COVID-19 severity and MM in the pathogenesis of thrombotic and other cardiovascular complications [ 43 ]. Furthermore, a longer time to respiratory deterioration after SARS-CoV-2 infection, compared to non-hematological subjects, also predicts mortality in MM patients, which suggests that prolonged clinical monitoring may be needed [ 44 ].…”

The possible role of nuclear factor erythroid‐2‐related factor 2 activators in the management of Covid‐19

“…[135] Indeed, Nrf2/HO-1/NQO1 axis is highly activated in the endothelial cells subjected to AGEs activators to provide an adaptive response against OS and/or inflammatory reactions in diabetes. [79,[136][137][138] An experimental study demonstrated that some herbal medicine like Eucommia ulmoides attenuates glucotoxicity by inhibiting AGEs through enhancement of the Nrf2 pathway in diabetic mice. [139] These findings proposed the potential anti-inflammatory effects of Nrf2 through inhibition expression of mTOR, AGEs, NF-κB, and NLRP3 inflammasome.…”