COVID-19 Led to Delayed Diagnoses, Increased Infection Risk, Lower Survival Rates in MM

The COVID-19 pandemic has placed a significant burden on the multiple myeloma (MM) population, leading to delayed MM diagnoses, decreased MM survival rates, and a higher risk of SARS-CoV-2, the virus that causes COVID-19, infection, according to a global study.

The large international multi-site real world data analysis that was published in Blood Cancer Journal represented the first published work that has demonstrated the hypothesized claim that there have been less new MM diagnoses during the pandemic compared with previous years.

“This study highlights the necessity of extending preventive measures worldwide to protect vulnerable patients from SARS-CoV-2 infection by promoting social distancing and an intensive COVID-19 vaccination strategies,” the investigators wrote.

Patients with MM are known to have varying degrees of multifactional immunodeficiency linked to the disease itself and anticancer therapies, resulting in an increased risk of infection. Although some studies have found that patients with MM have a high risk of hospitalization and death related to SARS-CoV-2 infections, there is no published data evaluating whether the MM population is at an increased risk of SARS-CoV-2 infection compared with the general population.

The researchers set out to confirm whether patients with MM were disproportionately impacted by COVID-19 infection and survival outcomes compared with patients without MM and. They also set out to provide comparative data on the occurrence of new MM diagnoses and the survival of MM between 2019 and 2020.

Using data from electronic medical records from health care organizations entered into a federated data research network, the investigators collected information on 7,748,356 patients, of whom 90,000 had MM, from 66 organizations. The patients with MM were matched with a control cohort of patients without MM who had visited a hospital in the last 5 years. The mean (SD) age of the entire global cohort was 69.68 (11.83) and 54.82% were men.

After conducting propensity score matched analysis, the authors found that the number of new diagnoses of MM was significantly reduced from 5357 to 4670 from 2019 to 2020, producing a risk ratio (RR) of 0.87 (95% CI, 0.84-0.91; P < .001). Additionally, patients who were diagnosed with MM in 2019 had a higher survival probability after 1 year after receiving their diagnosis compared to patients diagnosed in 2020.

In regard to COVID-19 infection, patients with MM demonstrated a higher risk of SARS-CoV-2 infection (RR, 1.72; 95% CI, 1.60-1.85) and a higher excess mortality rate in 2020 than patients without MM (9% difference; 95% CI, 4.4-13.2).

“The COVID-19 pandemic has overloaded our health systems globally; this resulted in a lack of attention to other pathologies that require very specialized diagnostic and therapeutic tools…. Our results could mean that globally around 15% of MM patients have not been diagnosed on time, or they have died because of the severe consequences on our health systems and patients,” the investigators concluded.

The study has some limitations, mainly regarding that electronic medical record data is subject to data entry errors and data gaps. Also, mortality data may have been incomplete.

The authors also noted that COVID-19 vaccines may be less effective in patients with hematological conditions, including MM, suggesting that patients might still be at an increased risk of SARS-CoV-2 infection event after complete vaccination and following protective protocols.

“Future studies assessing the efficacy of vaccines against SARS-CoV-2 in each particular hematological malignancy and evaluating the impact of the different therapies in the acquisition of COVID-19 immunity will help to optimize the vaccination strategy,” they suggested.

Reference

Martinez-Lopex J, Hernandez-Ibarburu G, Alonso R, et al. Impact of COVID-19 in patients with multiple myeloma based on a global data network. Blood Cancer J. 2021;11(12):198. doi: 10.1038/s41408-021-00588-z