COVID-19 infections and outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers

Hultcrantz, Malin; Richter, Joshua; Rosenbaum, Cara; Patel, Dhwani; Smith, Eric; Korde, Neha; Lu, Sydney; Mailankody, Sham; Shah, Urvi; Lesokhin, Alexander; Hassoun, Hani; Tan, Carlyn; Maura, Francesco; Derkacs, Andriy; Diamond, Benjamin; Rossi, Adriana; Pearse, Roger N.; Madduri, Deepu; Chari, Ajai; Kaminetsky, David; Braunstein, Marc; Gordillo, Christian; Davies, Faith; Jagannath, Sundar; Niesvizky, Ruben; Lentzsch, Suzanne; Morgan, Gareth; Landgren, Ola

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 10(th), 2020 and April 30(th,) 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.