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Multicenter Study of Spanish Patients Provides New Insights on COVID-19 in Multiple Myeloma

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In addition to age, sex, and comorbidities, a new study flagged uncontrolled cancer and renal insufficiency as key prognostic factors for COVID-19 outcomes.

As the coronavirus disease 2019 (COVID-19) pandemic evolves into subsequent waves in many parts of the world, there are many outstanding questions about the outcomes of infection for patients with multiple myeloma, specifically around the severity of outcomes, prognostic factors, and the effect of different treatments.  

A recent multicenter analysis of 167 hospitalized multiple myeloma patients with COVID-19 in Spain shines new light on some of those questions.1 Through comparison with an age- and sex-matched noncancer control group of COVID-19 patients, researchers found that mortality for those with multiple myeloma was 34% — 50% higher than for noncancer patients. This can be explained both by patient characteristics and factors related to the biology of multiple myeloma itself, the authors wrote.

In addition to older age, male sex, and comorbidities such as hypertension (which other multiple myeloma studies have previously identified), the study flagged presentation with active or progressive disease and comorbid renal disease as key prognostic factors. The study suggested that prior treatment had little effect on COVID-19 outcomes.

The patients enrolled in the study were treated at one of 73 hospitals throughout Spain during March and April 2020. They were compared with a same-sized noncancer group of COVID-19 patients with the same median age (71 years) and sex ratio (57%), and a similar number had at least 1 comorbidity — a key strength of the study, said Malin Hultcrantz, MD, PhD, hematologic oncologist at Memorial Sloan Kettering Cancer Center in New York City, who wasn’t involved in the research.

Seventy-seven percent of myeloma patients and 89% of noncancer patients presented with moderate to severe COVID-19. In addition, 8% vs 4% developed critical disease, and 47% vs 55% of patients required supplemental oxygen, respectively. However, more cancer patients underwent noninvasive and invasive ventilation (21% and 9%, respectively) compared to the control group (8% and 6%, respectively). In addition, compared with noncancer patients, myeloma patients tended to have lower median levels of neutrophils, lymphocytes, and platelets, and higher levels of ferritin and D-dimers — known risk factors for fatal outcomes of COVID-19.  

Despite the similar infection severity in both groups, 34% of myeloma patients died compared with 23% in the control group. Among cancer patients, mortality was higher in males compared to females (41% vs 24%), in patients 65 years or older compared with younger individuals (42% vs 16%), and in patients with hypertension or cardiac or pulmonary comorbidities.

That’s consistent with other studies on individuals with multiple myeloma and COVID-19, noted Ola Landgren, chief of the myeloma program and chair of the experimental therapeutics program at the Sylvester Comprehensive Cancer Center at the University of Miami, Florida. For instance, a study of 58 inpatients and outpatients with plasma-cell disorders — largely multiple myeloma — in New York City also found older age, male sex, and comorbidities such as hypertension and obesity to be significantly associated with hospitalization.2

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