MAINTAINING DELIVERY of HIGH QUALITYSpecialized care in patients with myeloma during the covid-19 pandemic: Comparing 2019 to 2020
Authors: E. Kastritis, M. Gavriatopoulou, M. Roussou, E. Eleutherakis-Papaiakovou, M. Migkou, N. Kanellias, D. Fotiou, I. Ntanasis-Stathopoulos, F. Theodorakakou, P. Malandrakis, E. Terpos, M. A. Dimopoulos
Journal: HemaSphere (2021)

Background: The SARS-CoV-2 pandemic has caused innumerable social and economic consequences, has stressed health care systems, affecting the delivery of health care and raising concerns that many patients may have suffered delays in therapy and in the diagnosis of serious conditions, such as hematologic and other malignancies. This effect may be more pronounced in older patients, who are at higher risk for COVID-19 complications, but which may also be affected by social isolation and distancing, difficulties in reaching health care facilities and fear of acquiring the infection. Myeloma patients are a vulnerable, mostly elderly population who may have been affected in terms of diagnosis and treatment delivery during the pandemic. There is a concern that diagnosis may be delayed, potentially presenting with more advanced disease or more often with severe complications. Aims: To provide evidence for the care of patients with myeloma, during the COVID-19 era, we compared the characteristics of newly diagnosed patients during 2020 and 2019 (i.e pre COVID-19 pandemic). Methods: We compared baseline characteristics and short-term outcomes of newly diagnosed MM patients who were diagnosed and started therapy in a tertiary referral center (Department of Clinical Therapeutics, Athens) during two calendar periods, 2019 and 2020. Initial restrictive measures were first implemented in Greece in mid-February 2020 and national lockdown in mid-March. Data were collected through our prospectively maintained database that includes all patients with a diagnosis of myeloma in our center. Since the beginning of the pandemic in Greece, our department implemented preventive measures and operating procedures to ensure continuous delivery of care and reduce the risk of COVID-19 infection. Results: In 2019,125 MM patients with a new diagnosis of symptomatic disease started therapy vs101 in 2020. The distribution of new cases per month was similar between the two years (p=0.542). Gender distribution was similar, but patients diagnosed in 2020 were slightly older (median 69 vs 66 years for 2019, p=0.084). There were no differences in baseline anemia, renal function, need for dialysis or ISS stage;however, slightly more patients had high risk cytogenetics in 2020 vs 2019 (37% vs 27%, p=0.129). The median time from the first test for the diagnosis to start of therapy was15 days in 2019 vs 8 days in 2020. First line therapies were similar with the majority receiving a PI plus IMiD combination (mostly VRD: 70% in 2019 vs 76% in 2020). Radiotherapy due to MM-related complications was required in 2.4% vs 4% of patients in 2019 and 2020 respectively. Early mortality (death <3 months from start of therapy) was 2.4% in 2019 and 5% in 2020 (p=0.314). The number of autologous transplants was slightly smaller in 2020 vs 2019 (54 vs 61). Infection rates during induction, which may have been affected by the use of social distancing and protective measures, was similar (15% vs16%);however, less patients required hospitalization for infection management in 2020 (in 8% vs16% in 2019). Very few cases of COVID-19 occurred among our MM patients and in only one newly diagnosed MM patient. Summary/Conclusion: Despite the pandemic, we did not observe significant delays or changes in the characteristics of patients that were diagnosed with myeloma between 2019 and 2020 in our center, neither in the short-term outcomes of our patients. Despite the pandemic it is possible to maintain delivery of high-quality specialized care in patients with myeloma.