COVID-19 Mortality in concurrent multiple myeloma (mm) - A prospective and comparative case series through the first and second wave of the sars-cov-2 pandemic in a uk tertiary haematology centre
Authors: S. Shaya, S. Choudhuri
Journal: HemaSphere (2021)

Background: The Sars-CoV-2 pandemic has markedly disrupted haemato- oncology services in the UK in balancing Covid-19 infection risk with MM management. New light has been shed on risk factors for mortality in hospitalised Covid-19 patients with concurrent MM. However, reported mortality rates for Covid-19 in MM patients show significant heterogeneity between countries, and do not examine for changes to mortality despite huge shifts in Covid-19 management throughout the pandemic. Aims: 1) Record patient demographics and medical risk factors of all MM patients hospitalised with Covid-19 between March 2020 to January 2021 in the NCA (catchment population of ~1,000,000 patients), UK. 2) Compare patient factors and outcomes between the first and second wave of the Sars-CoV-2 pandemic to characterise more currently reflective demographic and outcome data for Covid-19 in MM patients. Methods: All patients with a previous diagnosis of MM who were admitted Covid-19 treatment were included. Covid-19 diagnosis was defined as a positive nasopharyngeal PCR swab 7 days before or after admission. Admissions during the 01/03/2020 to 30/06/2020 and 01/07/2020 to 07/01/2021 were included, and classified as the first and second wave, respectively. Patient demographics, myeloma therapy before admission, medical co-morbidities, and 28-day mortality from Covid-19 test positivity was recorded and analysed. Statistical comparison of mortality rate was applied between the first and second wave. Results: 6 patients were admitted in the first wave of whom 6 (100%) died. 6 patients were admitted in the second wave, of whom 2 (33.3%) died. The change in mortality between waves approached, but fell short of, statistical significance (p=0.061). The average age in both waves was 79 and both had heterogeneous but comparable medical co-morbidities. Gender did not correlate to mortality, and gender ratios were comparable between both groups. 10 of 12 patients had medical therapy for MM prior to their admission, 7 of which were bortezomib based, two lenalidomide- Ixazomib based, and one receiving pomalidomide monotherapy. No correlation was detected between specific MM therapy or therapy line, on pandemic wave or mortality. Summary/Conclusion: This study seeks to define more up to date Covid-19 outcomes in MM patients compared to previous outcome data which uses both early and current Covid-19 outcome data, homogenously. Our findings are strictly limited by sample size and power but display a large difference in Covid-19 mortality rate between the first and second wave in the NCA. Due to comparable patient and medical characteristics, and near statistical significance, these findings suggest a significant reduction in mortality of Covid- 19 in MM patients between the first and second Sars-CoV-2 wave in the UK and is a novel finding which warrants further study to confirm or refute this. A more representative set of outcome statistics for Covid-19 infection in MM patients would represent today's pandemic and may shed light on the impact of previously implemented changes in MM management as well as advances in Covid-19 inpatient care. Finally, an accurate representation of today's Covid-19 outcomes in MM patients would set the benchmark for comparing interventional outcomes going forward.