High mortality rate observed in patients with multiple myeloma, COVID-19

Author: Denise Baez

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Patients with multiple myeloma who were hospitalised with coronavirus disease 2019 (COVID-19) had a high mortality rate, with significant geographic variability, ranging from 27% to 57%, according to the first results from the International Multiple Myeloma COVID-19 dataset, published in the journal Blood.

The International Multiple Myeloma COVID-19 dataset, created by the International Myeloma Society, included data from 650 patients with a plasma cell disorder (95.5% multiple myeloma) from 10 different countries and multiple centres — all with laboratory-confirmed COVID-19. Most of the patients were from Spain (28.62%), France (28.46%), the United States (19.38%), and the United Kingdom (14.77%).

Of the patients, 33% died following their COVID-19 diagnosis. The mortality rate ranged from 4% among outpatients, to 31% among patients who were hospitalised but did not require ventilator support, to an alarming 80% among hospitalised patients who required ventilator support. The death rate among patients with other plasma cell disorders besides multiple myeloma was 31% (9 of 29).

There was a wide variability in death rates across the 4 major countries, with an overall mortality rate of 30.1% in Spain, 37.2% in France, 24.6% in the United States, and 55.2% in the United Kingdom. Among hospitalised patients not requiring ventilator support, the mortality rates were 30.26%, 26.52%, 21.57%, and 53.66%, respectively. Mortality rates among patients that were hospitalised and required invasive ventilation were 60%, 83.78%, 94.44%, and 100%, respectively.

“The high mortality noted in patients with multiple myeloma highlights the critical importance of measures to prevent contracting COVID-19, such as social distancing and wearing masks,” wrote Ajai Chari, MD, Mount Sinai Hospital, New York, New York, and colleagues.

Of the patients, 54% were receiving first-line treatment; 23.5% had received ≥3 lines of therapy. Of the patients with known treatment status, 87% were on active multiple myeloma therapy at the time of COVID-19 diagnosis, and 89% patients had their therapy held during COVID-19 diagnosis and management. About a third of patients had been diagnosed with multiple myeloma recently.

“In our cohort, 36% of the patients with COVID-19 infection were diagnosed with multiple myeloma in 2019-20, suggesting higher susceptibility even in earlier stages of the disease,” the authors wrote. “Even if we account for variability in diagnosis and selection of cases, there seems to be no evidence of increased hospitalisations in advanced multiply relapsed multiple myeloma, as it was initially postulated.”

The most frequent COVID-19 treatments included combination strategies (70%), antibiotics (14%), and hydroxychloroquine (10%). None of the treatments appeared to be protective or associated with worse outcomes.

In contrast to previous reports, sex was not associated with COVID-19 outcomes among patients with multiple myeloma. Neither time from diagnosis nor number of prior lines of treatment had any impact on outcome of COVID-19 infection, nor did history of transplant, including transplants that occurred within a year of COVID-19 diagnosis.

Univariate analysis identified age (P = .001), ISS3 (P = .04), high-risk disease (P = .07), renal disease (P = .007), suboptimal myeloma control (P = .01), and ≥1 comorbidities (P = .04) as risk factors for higher rates of death.

“The management of multiple myeloma 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 treatment,” the authors concluded.