Redefining outcomes in multiple myeloma in covid-19 infected patients. Reconsidering the thrombosis and infective risk
Authors: H. Fernandez-Leyva
Journal: HemaSphere (2021)

Background: There role and factors about susceptibility to the outcome of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients with multiple myeloma (MM) with a thrombotic event presents numerous challenges. As MM is a disease of the elderly, characterised by immunosupresion, hence, patients with MM might be considered more susceptible to severe complications from COVID-19. Aims: To evaluate the outcomes in the COVID myeloma hospitalised population. Methods: We undertook this retrospective study to characterise the baseline and outcome data of COVID-19 infection in 50 patients with plasma cell disorders, collected by two different Trust institutional analysis to identify potential predictors of outcome. Apart from the specific MM-related symptoms, most patients display Infections and thrombosis as more common disease complications, and unfortunately remain a major cause of death. Patients with MM and confirmed COVID-19 diagnosed between January 2020 to January 2021, Furthermore, corticosteroids, and especially dexamethasone, are used as for hospitalised MM patients. Results: The 39% presented with severe COVID-19 (need of oxygen and/ or intensive care support - admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79- 7.71]). 39.7% with severe COVID-19 were receiving or had recent (≤ 12 months) treatment for MM at the time of COVID-19 versus (patients with mild stable disease. Hospitalisation rate for severe COVID-19 was lower (p < 0.05) for patients on oral regimen (IMIDs) and good control paraprotein versus those on other regimens or off treatment. the median age was 71 years, and all patients received at least one line of previous treatment. Approximately 36% were recently diagnosed (2019- 2020), and only 32% of patients were receiving first-line therapy. The mortality associated to admission were approximately 6 % of hospitalised patients. More of the half of the patient (54%) had at leat one previous cardiovascular positive past medical history. In addition, patients were long hospitalised or partially immobilised or 23% patients received previous ESAs (EPO) or severe renal impairment. The principal thrombotic event were segmental pulmonary embolism and in less proportion STEMI, renal infarct or stroke. In the mean time they received LMWH prophylaxis was 4.7 months. After reevaluation of thrombotic risk, most of the patients maintained LMWH with more strict control and in the group with good outcomes switched to DOAC. There were no cases of severe bleeding complications with the use of adequate thromboprophylaxis. Univariate analysis identified age, International Staging System stage III (ISS-III), renal disease, high-cytogenetics risk disease, delays (toxicities) or suboptimal myeloma control (active or progressive disease), and more than two co-morbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of diagnosis, nor other anti-MM treatments were associated with outcomes. Summary/Conclusion: Age and co-morbidities did impact on mortality, alluding to a relevant role of MM and immunodeficiency. Among hospitalised patients, We did not observe any significant correlation between active PI, IMiD, anti-CD38 monoclonal antibody, alkylating agents, steroids, or other treatments and the COVID-19 outcome. The management of MM in the era of COVID-19 requires careful consideration of individual approach- and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising disease control through appropriate MM treatment.