Risk Factors for Increased Mortality Among Patients With MM, COVID-19 Identified

Age, renal disease, suboptimal myeloma control, International Staging System (ISS) stage 3, high-risk disease, and 1 or more comorbidities were identified in a recent International Myeloma Society retrospective study as increasing the risk of death from coronavirus disease 2019 (COVID-19) for patients being treated for multiple myeloma (MM), according to findings published in Blood.

Suboptimal myeloma control was defined as having active or progressive disease.

“The primary cause of morbidity and mortality in patients with MM is an infection,” the authors noted. Their goal with the current investigation was to formulate a greater understanding on what may predispose these patients to death if they acquire COVID-19 in order to better manage their treatment.

Data collected by the International Myeloma Society on 650 patients with plasma cell disorders were analyzed for those hospitalized during the pandemic. Ninety-six percent had MM; just over one-third (36.0%) had received their diagnosis in 2019 or 2020; most were from Spain (28.6%), France (28.5%), or the United States (19.4%); and all had a confirmed positive test for SARS-CoV-2, the virus that causes COVID-19. The median age was 69 (range, 34-92) years.

Overall results show that 55.2% of patients had the immunoglobulin G subtype of MM, followed by immunoglobulin A (21.6%) and light chain (20.0%) subtypes. The most common disease stage was ISS 1/2 in 68.4%. High-risk cytogenetics and renal dysfunction were seen in 32.1% and 26.5%, respectively.

Mortality rates varied among the patients with MM, ranging from 4% for outpatients to 31% and 80%, respectively, for hospitalized patients not on or those requiring use of a ventilator.

For age as a risk factor, a significant association (P < .001) with mortality was seen with increasing age in those with MM and COVID-19. For example, the mortality rate was 49.3% among patients at least 80 years old compared with 17.8% for 40-year-old patients. Univariate analysis also identified the following associations:

• ISS stage 3 vs stage 1 disease (P = .04)
• High-risk MM (ie, del 17p, t[4;14], amp 1q, or t[14;16]) (P = .07)
• Renal disease (P = .007)
• Suboptimal MM control (P = .01)
• 1 or more comorbidities (P = .04)

Transplant status did not affect outcomes, whether the transplant took place at any time prior, within a year of COVID-19 diagnosis, or during a period of 6 months before to 6 months after COVID-19 diagnosis.

Following multivariate analysis, age, high-risk MM, renal disease, and suboptimal MM control continued to have significant associations with mortality:

• Age (odds ratio [OR], 1.04; 95% CI, 1.01-1.08)
• High-risk MM (OR, 2.35; 95% CI, 1.20-4.66)
• Renal disease (OR, 2.71; 95% CI, 1.23-6.08)
• Suboptimal MM control (OR, 1.91; 95% CI, 0.96-3.81)

“This collaborative international effort provides the first large-scale analysis and initial IMS suggestions on the management of, and outcomes for, patients with MM during the current COVID-19 pandemic,” the authors concluded. “As the pandemic and data accumulation rapidly increase, we need prospective studies on treatment options and additional patient characteristics to further understand the variables associated with COVID-19–associated death in MM patients.”

Current recommendations for management of these patients include not avoiding treatment for MM, although “the risk/benefit of MM therapy should be weighed against an individual’s risk factors for COVID-19 complications”; conducting polymerase chain reaction testing in patients with a new diagnosis of MM, and closely monitoring patients with MM and the higher-risk factors identified here.

Reference

Chari A, Samur MK, Martinez-Lopez J, et al. Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set. Blood. 2020;136(26):3033-3040. doi:10.1182/blood.2020008150