Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set

  1. Ajai Chari
  2. Mehmet Kemal Samur
  3. Joaquin Martinez-Lopez
  4. Gordon Cook
  5. Noa Biran
  6. Kwee Yong
  7. Vania Hungria
  8. Monika Engelhardt
  9. Francesca Gay
  10. Ana García Feria
  11. Stefania Oliva
  12. Rimke Oostvogels
  13. Alessandro Gozzetti
  14. Cara Rosenbaum
  15. Shaji Kumar
  16. Edward A. Stadtmauer
  17. Hermann Einsele
  18. Meral Beksac
  19. Katja Weisel
  20. Kenneth C. Anderson
  21. María-Victoria Mateos
  22. Philippe Moreau
  23. Jesus San-Miguel
  24. Nikhil C. Munshi
  25. Hervé Avet-Loiseau

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Abstract

The primary cause of morbidity and mortality in patients with multiple myeloma (MM) is an infection. Therefore, there is great concern about susceptibility to the outcome of COVID-19–infected patients with MM. This retrospective study describes the baseline characteristics and outcome data of COVID-19 infection in 650 patients with plasma cell disorders, collected by the International Myeloma Society to understand the initial challenges faced by myeloma patients during the COVID-19 pandemic. Analyses were performed for hospitalized MM patients. Among hospitalized patients, the median age was 69 years, and nearly all patients (96%) had MM. Approximately 36% were recently diagnosed (2019-2020), and 54% of patients were receiving first-line therapy. Thirty-three percent of patients have died, with significant geographic variability, ranging from 27% to 57% of hospitalized patients. Univariate analysis identified age, International Staging System stage 3 (ISS3), high-risk disease, renal disease, suboptimal myeloma control (active or progressive disease), and 1 or more comorbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of COVID-19 diagnosis, nor other anti-MM treatments were associated with outcomes. Multivariate analysis found that only age, high-risk MM, renal disease, and suboptimal MM control remained independent predictors of adverse outcome with COVID-19 infection. The management of MM in the era of COVID-19 requires careful consideration of patient- and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising disease control through appropriate MM treatment. This study provides initial data to develop recommendations for the management of MM patients with COVID-19 infection.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.24.20177576: (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:
    Within the limitation of our sample size and retrospective nature of the study, there is no clear suggestion for need to avoid any specific MM treatment. Importantly, patients with good MM control (complete response, CR) had superior outcome compared to those with relapsed disease or partial response (PR). A similar finding was observed in a study of 928 cancer patients with COVID-19 where patients with active cancer (progressing vs remission) had an adjusted odds ratio of 5.2 for 30 day mortality but there was no association with recent non-cytotoxic therapy nor recent cytotoxic systemic chemotherapy2. As most patients receive dexamethasone as part of combination therapy, it was not possible to judge its independent impact on outcome. This is important since a recent report suggests superior survival for those COVID-19 patients given dexamethasone as part of their COVID-19 therapy23. Our multivariate model identifies age, high risk or progressive MM, and presence of renal disease as indicators of poor outcome. MM therapy to achieve deep response may therefore also protect patients from adverse outcome from COVID-19 infection. While little is known about the recovery of patients with MM from COVID-19 infection, Wang et al found that the median time to PCR negativity was 43 (range 19-68) days from initial positive PCR24. Interestingly, 96% (22/23) of MM patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. Based on the observations reporte...

    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

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  2. Version published to 10.1182/blood.2020008150
  3. Version published to 10.1101/2020.08.24.20177576v1 on medRxiv