COVID-19 infections and 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 Rosenbaum
  4. Dhwani Patel
  5. Eric Smith
  6. Neha Korde
  7. Sydney Lu
  8. Sham Mailankody
  9. Urvi Shah
  10. Alexander Lesokhin
  11. Hani Hassoun
  12. Carlyn Tan
  13. Francesco Maura
  14. Andriy Derkacs
  15. Benjamin Diamond
  16. Adriana Rossi
  17. Roger N. Pearse
  18. Deepu Madduri
  19. Ajai Chari
  20. David Kaminetsky
  21. Marc Braunstein
  22. Christian Gordillo
  23. Faith Davies
  24. Sundar Jagannath
  25. Ruben Niesvizky
  26. Suzanne Lentzsch
  27. Gareth Morgan
  28. Ola Landgren
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Abstract

Importance

New York City is a global epicenter for the SARS-CoV-2 outbreak with a significant number of individuals infected by the virus. Patients with multiple myeloma have a compromised immune system, due to both the disease and anti-myeloma therapies, and may therefore be particularly susceptible to coronavirus disease 2019 (COVID-19); however, there is limited information to guide clinical management.

Objective

To assess risk factors and outcomes of COVID-19 in patients with multiple myeloma.

Design

Case-series.

Setting

Five large academic centers in New York City.

Participants

Patients with multiple myeloma and related plasma cell disorders who were diagnosed with COVID-19 between March 10th, 2020 and April 30th,2020.

Exposures

Clinical features and risk factors were analyzed in relation to severity of COVID-19.

Main Outcomes and Measures

Descriptive statistics as well as logistic regression were used to estimate disease severity reflected in hospital admissions, intensive care unit (ICU) admission, need for mechanical ventilation, or death.

Results

Of 100 multiple myeloma patients (male 58%; median age 68, range 41-91) diagnosed with COVID-19, 74 (74%) were admitted; of these 13 (18%) patients were placed on mechanical ventilation, and 18 patients (24%) expired. None of the studied risk factors were significantly associated (P>0.05) with adverse outcomes (ICU-admission, mechanical ventilation, or death): hypertension (N=56) odds ratio (OR) 2.3 (95% confidence interval [CI] 0.9-5.9); diabetes (N=18) OR 1.1 (95% CI 0.3-3.2); age >65 years (N=63) OR 2.0 (95% CI 0.8-5.3); high dose melphalan with autologous stem cell transplant <12 months (N=7) OR 1.2 (95% CI 0.2-7.4), IgG<650 mg/dL (N=42) OR=1.2 (95% CI 0.4-3.1). In the entire series of 127 patients with plasma cell disorders, hypertension was significantly associated with the combined end-point (OR 3.4, 95% CI 1.5-8.1).

Conclusions and Relevance

Although multiple myeloma patients have a compromised immune system due to both the disease and therapy; in this largest disease specific cohort to date of patients with multiple myeloma and COVID-19, compared to the general population, we found risk factors for adverse outcome to be shared and mortality rates to be within the higher range of officially reported mortality rates.

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