Data from COVID-19 Infections and Clinical Outcomes in Patients with Multiple Myeloma in New York City: A Cohort Study from Five Academic Centers

  1. Malin Hultcrantz
  2. Joshua Richter
  3. Cara A. Rosenbaum
  4. Dhwani Patel
  5. Eric L. Smith
  6. Neha Korde
  7. Sydney X. Lu
  8. Sham Mailankody
  9. Urvi A. Shah
  10. Alexander M. Lesokhin
  11. Hani Hassoun
  12. Carlyn Tan
  13. Francesco Maura
  14. Andriy Derkach
  15. Benjamin Diamond
  16. Adriana Rossi
  17. Roger N. Pearse
  18. Deepu Madduri
  19. Ajai Chari
  20. David Kaminetzky
  21. Marc J. Braunstein
  22. Christian Gordillo
  23. Ran Reshef
  24. Ying Taur
  25. Faith E. Davies
  26. Sundar Jagannath
  27. Ruben Niesvizky
  28. Suzanne Lentzsch
  29. Gareth J. Morgan
  30. Ola Landgren

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

<div>Abstract<p>Patients with multiple myeloma have a compromised immune system, due to both the disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in patients with multiple myeloma treated at five large academic centers in New York City in the spring of 2020, during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these, 13 patients (17%) were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 nonadmitted patients, 4 were asymptomatic. There was a higher risk of adverse outcome (intensive care unit admission, mechanical ventilation, or death) in Hispanics/Latinos (<i>n</i> = 21), OR = 4.7 (95% confidence interval, 1.3–16.7), and African American Blacks (<i>n</i> = 33), OR = 3.5 (1.1–11.5), as compared with White patients (<i>n</i> = 36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated (<i>P</i> > 0.05) with adverse outcome: hypertension (<i>n</i> = 56), OR = 2.2 (0.9–5.4); diabetes (<i>n</i> = 18), OR = 0.9 (0.3–2.9); age >65 years (<i>n</i> = 63), OR = 1.8 (0.7–4.6); high-dose melphalan with autologous stem cell transplant <12 months (<i>n</i> = 7), OR = 0.9 (0.2–5.4); and immunoglobulin G <650 mg/dL (<i>n</i> = 42), OR = 0.9 (0.3–2.2). In this largest cohort to date of patients with multiple myeloma and COVID-19, we found the case fatality rate to be 29% among hospitalized patients and that race/ethnicity was the most significant risk factor for adverse outcome.</p>Significance:<p>Patients with multiple myeloma are immunocompromised, raising the question whether they are at higher risk of severe COVID-19 disease. In this large case series on COVID-19 in patients with multiple myeloma, we report 29% mortality rates among hospitalized patients and identify race/ethnicity as the most significant risk factor for severe outcome.</p><p><i>See related video:</i> <a href="https://vimeo.com/486246183/559a80cfae" target="_blank">https://vimeo.com/486246183/559a80cfae</a></p><p><i>See related commentary by Munshi and Anderson, p. 218</i>.</p><p><i>This article is highlighted in the In This Issue feature, p. 215</i></p></div>

Article activity feed

  1. Version published to 10.1158/2643-3230.c.6550092.v1
  2. Version published to 10.1158/2643-3230.22542939.v1
  3. Version published to 10.1158/2643-3230.c.6550092
  4. Version published to 10.1158/2643-3230.22542939
  5. Version published to 10.1158/2643-3230.bcd-20-0102
  6. ScreenIT

    SciScore for 10.1101/2020.06.09.20126516: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Limitations of this study includes it being a case-series from tertiary cancer centers with a selected patient population in which patients who were treated at local hospitals in the outpatient setting were less likely to be included. There was missing data for certain laboratory results for some of the patients, primarily those who were treated as outpatients where not all tested for C-reactive protein, ferritin, D-dimer, or IL-6 levels. In summary, we present data on a large case-series of COVID-19 positive patients with multiple myeloma and related precursor diseases showing case fatality rates in the higher range of reports from the general population. We comprehensively investigated the role of other comorbidities and found that the strongest risk factors for severe outcome were similar to those in the general population. The molecular and immunological mechanisms responsible for this finding remain unclear; however, given that patients with multiple myeloma are at an increased risk of various other infections due to both disease and treatment associated immunosuppression 17, current recommendation by American Society of Hematology and the International Myeloma Society state that high-dose melphalan chemotherapy followed with autologous stem cell transplant should be postponed, if possible, until the pandemic levels off.25,26 Ongoing larger studies with a wide range of hematological malignancies will provide additional information on geographical variations of risk facto...

    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.

  7. Version published to 10.1101/2020.06.09.20126516v1 on medRxiv