Multiple myeloma and SARS-CoV-2 infection: clinical characteristics and prognostic factors of inpatient mortality

  1. Joaquín Martínez-López
  2. María-Victoria Mateos
  3. Cristina Encinas
  4. Anna Sureda
  5. José Ángel Hernández-Rivas
  6. Ana Lopez de la Guía
  7. Diego Conde
  8. Isabel Krsnik
  9. Elena Prieto
  10. Rosalía Riaza Grau
  11. Mercedes Gironella
  12. María Jesús Blanchard
  13. Nerea Caminos
  14. Carlos Fernández de Larrea
  15. María Alicia Senin
  16. Fernando Escalante
  17. José Enrique de la Puerta
  18. Eugenio Giménez
  19. Pilar Martínez-Barranco
  20. Juan José Mateos
  21. Luis Felipe Casado
  22. Joan Bladé
  23. Juan José Lahuerta
  24. Javier de la Cruz
  25. Jesús San-Miguel

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Abstract

There is limited information on the characteristics, prognostic factors, and outcomes of patients with multiple myeloma (MM) hospitalized with COVID-19. This retrospective case series investigated 167 patients reported from 73 hospitals within the Spanish Myeloma Collaborative Group network in March and April, 2020. Outcomes were compared with 167 randomly selected, contemporary, age-/sex-matched noncancer patients with COVID-19 admitted at six participating hospitals. Among MM and noncancer patients, median age was 71 years, and 57% of patients were male; 75 and 77% of patients, respectively, had at least one comorbidity. COVID-19 clinical severity was moderate–severe in 77 and 89% of patients and critical in 8 and 4%, respectively. Supplemental oxygen was required by 47 and 55% of MM and noncancer patients, respectively, and 21%/9% vs 8%/6% required noninvasive/invasive ventilation. Inpatient mortality was 34 and 23% in MM and noncancer patients, respectively. Among MM patients, inpatient mortality was 41% in males, 42% in patients aged >65 years, 49% in patients with active/progressive MM at hospitalization, and 59% in patients with comorbid renal disease at hospitalization, which were independent prognostic factors on adjusted multivariate analysis. This case series demonstrates the increased risk and identifies predictors of inpatient mortality among MM patients hospitalized with COVID-19.

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  1. Version published to 10.1038/s41408-020-00372-5
  2. ScreenIT

    SciScore for 10.1101/2020.06.29.20142455: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Institutional Review Board (IRB) of Hospital Universitario 12 de Octubre (n 20/208).
    RandomizationAdditionally, a series of patients with no cancer history, matched by age and sex, were randomly selected from cohorts of COVID-19 patients admitted during the same time period at 6 participating hospitals.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    22 Analyses were generated using SAS/STAT software, Version 9.4, SAS Institute Inc.
    SAS/STAT
    suggested: None
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The non-participation of MM patients with unconfirmed COVID-19 or who were not hospitalized is a limitation in terms of the broader applicability of the study results. Further studies could be conducted to implement our analysis protocol in a less restricted population of patients. Another limitation is that our study is not able to identify optimal management and treatment of newly diagnosed MM patients with COVID-19. In conclusion, MM patients hospitalized with SARS-CoV-2 infection have a higher inpatient mortality rate than non-cancer patients. This had been suspected since the beginning of the COVID-19 pandemic, and consequently national and international societies have published or made general recommendations about optimal management of MM patients. Our study assessed the impact of prior MM treatments based on immunomodulatory drugs, proteasome inhibitors, or monoclonal antibodies, and none of these influenced in the inpatient mortality rate. Although we cannot answer the question of whether to treat or not – and how – during the pandemic, we can stress the need for appropriate disease control in all patients, to minimize hospital visits, particularly in the most vulnerable MM populations such as male patients, those aged >65 years (who are already at high risk, even at this relatively young age), and those with renal impairment, which is the most critical factor. Accordingly, MM patients requiring treatment due to active disease should be tested for COVID-19 by PCR and...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.29.20142455v1 on medRxiv