A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

  1. Bo Wang
  2. Oliver Van Oekelen
  3. Tarek H. Mouhieddine
  4. Diane Marie Del Valle
  5. Joshua Richter
  6. Hearn Jay Cho
  7. Shambavi Richard
  8. Ajai Chari
  9. Sacha Gnjatic
  10. Miriam Merad
  11. Sundar Jagannath
  12. Samir Parekh
  13. Deepu Madduri

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Abstract

Background

The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the USA. Our institution has treated over 2000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York.

Methods

We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020, and April 30, 2020. We report epidemiological, clinical, and laboratory characteristics including the persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes.

Results

Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-White. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%), and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (> 70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly ( p < 0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant ( p < 0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-White race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. The median time to PCR negativity was 43 (range 19–68) days from initial positive PCR.

Conclusions

Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality. Mounting a severe inflammatory response to SARS-CoV-2 and severe hypogammaglobulinemia was associated with higher mortality. The majority of patients mounted an antibody response to SARS-CoV-2. These findings pave a path to the identification of vulnerable MM patients who need early intervention to improve outcomes in future outbreaks of COVID-19.

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  1. Version published to 10.1186/s13045-020-00934-x
  2. Version published to 10.1101/2020.06.04.20122846v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.06.04.20122846: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This retrospective study was approved by the institutional review board (IRB) of the Mount Sinai Hospital and is in compliance with the Declaration of Helsinki and International Conference on Harmonization Guidelines for Good Clinical Practice (IRB: GCO#: 11-1433).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Anti-SARS-CoV-2 antibody testing was performed using an anti-IgG assay developed at Mount Sinai Health System Department of Pathology in collaboration with the Icahn School of Medicine at Mount Sinai Department of Microbiology under a Food and Drug Administration (FDA) Emergency Use Authorization.
    Anti-SARS-CoV-2
    suggested: None
    anti-IgG
    suggested: None

    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:
    This study has the limitations of single institution, retrospective reporting of a smaller cohort of patients. Serological data were not available for a minority of the patients who were hospitalized at outside institutions. The observations reported here have to be confirmed by a larger series of data collected from multiple institutions and such efforts are underway. Few patients received COVID-19 directed treatment on clinical trials. The role of recently emergency approved anti-viral agent remdesivir or convalescent plasma should be explored in the high-risk population with myeloma.

    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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  4. Version published to 10.1101/2020.06.04.20122846v1 on medRxiv