MM Progression, Treatment Do Not Appear to Impact COVID-19 Mortality, Study Finds

A new report from an early coronavirus disease 2019 (COVID-19) hotspot offers insights into the experiences of patients with multiple myeloma (MM) who contracted the SARS-CoV-2 virus.

The report, a preprint published by MedRxiv,¹ outlines cases of patients with plasma cell disorders and COVID-19 who were treated at Mount Sinai Hospital in New York City, which was the early epicenter of the pandemic. Mount Sinai alone treated 2000 patients with the disease. The report covers the period from March 1 to April 30 of this year.

Among those 2000 patients, corresponding author Deepu Madduri, MD, and colleagues identified a cohort of 58 patients with either MM (54 patients) or smoldering MM (4 patients) who sought treatment for COVID-19. Broadly speaking, MM did not appear to have a direct impact on mortality; issues such as drug exposure or disease progression had no significant effect on a patient’s chance of survival.

“In contrast, we observed that age and cardiovascular risk factors (diabetes, CAD, CHF) were significantly associated with patient hospitalization for COVID-19,” the authors wrote.

Patients who mounted a severe inflammatory response to SARS-CoV-2 and those who had severe hypogammaglobulinemia were most at risk for mortality, according to the study.

Overall, Madduri and colleagues said 36 of the 58 patients with MM were hospitalized after being diagnosed with COVID-19; the remaining 22 were treated successfully at home. Fourteen patients within the cohort eventually died from the disease.

Risk factors for hospitalization were those over the age of 70, men, those with cardiovascular risk, and those who were not in complete remission (CR) or stringent CR.

Of the 36 patients who ended up in the hospital, 23 were admitted at Mt. Sinai. The majority (79%) had a fever at the time of admission, and nearly half (48%) were tachycardic with a heart rate exceeding 100 beats per minute. Those rates would increase over the course of the patients’ stays. Eventually 95% of patients developed a fever and 78% became tachycardic. Ten of the patients needed immediate oxygen support upon admission, and 2 patients required intubation and mechanical ventilation. The median hospital stay was 22 days.

Seven of the patients admitted to Mt. Sinai died (30%). When the authors added in 7 additional deaths among the patients hospitalized elsewhere, the mortality rate among the 36 hospitalized patients was 39%.

Madduri and colleagues noted that these mortality rates were in line with mortality rates among all people over the age of 45 who were admitted to the hospital with COVID-19 in New York as of May 25.² The rate was lower, however, than the 54% mortality rate reported in a similar study in the United Kingdom.³

Given the apparent lack of impact of MM itself on mortality, the authors said there’s no evidence suggesting clinicians need to change the management of myeloma patients in the wake of the pandemic; as a preprint, the article has not been peer reviewed and should not be used to guide practice decisions. Still, they said physicians must take a proactive approach to monitoring patients with MM given the risk of COVID-19.

“[Earlier] diagnosis of COVID-19 and prompt intervention especially for the vulnerable population identified above is warranted to reduce the risk of mortality,” they wrote. “As we reopen and move forward into a post-COVID-19 era, we will need to remain vigilant, particularly for select patient groups, and await effective COVID-19 treatments while balancing the need to manage patients’ myeloma.”

References:

1. Wang B, Van Oekelen O, Mouhieddine TH, et al. A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward. Preprint. medRxiv. 2020;2020.06.04.20122846. Published 2020 June 5. doi:10.1101/2020.06.04.20122846

2. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775

3. Cook G, John Ashcroft A, Pratt G, et al. 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. Br J Haematol. Published online May 21, 2020. doi:10.1111/bjh.16874