Real World Update on COVID and Myeloma From Five NYC Myeloma Centers

Researchers from five different myeloma academic centers in New York City joined together to study the impact of COVID-19 on multiple myeloma patients (MSKCC, Mount Sinai, Columbia University, NYU Langone, and Weill Cornell).

Data gathered from the height of the NYC outbreak in the spring of 2020 (March 1 - April 30) showed that there was a higher risk of hospitalizations or death (29%) for myeloma patients compared to the general population (6-26%).

The study findings on COVID-19 related mortality (22% in the whole group of myeloma patients and 29% of those admitted) are in line with recent reports on a high mortality in patients with all blood cancers in relation to the general population.

The researchers wanted to better understand the risk factors involved and found that there were worse outcomes outcomes (ICU-admission, ventilation or death) in Hispanic/Latinos and African Americans as compared to white patients. The patients with severe outcomes had overall higher levels of inflammatory markers and cytokine activation.

Additional risk factors that led to higher severity outcomes included pre-existing hypertension and cardiovascular issues, similar to the general population. 

Because some myeloma treatments (like CD38 antibodies and stem cell transplant) can reduce the function of the immune system, the investigators wanted to see if certain myeloma therapies led to worse outcomes. The study did not find a relationship between certain myeloma therapies, or prior stem cell transplant, in the prior 12 months and poor outcomes. 

In the general population, patients with severe COVID-19 have high Interleukin-6 (an inflammatory marker), low HLA-DR (a cell surface receptor) and changes to immune system lymphocytes (lower levels of CD4 and B cells). 

In the myeloma patients, the doctors found high Interleukin-6, elevated ferretin (iron) and low absolute lymphocyte levels. Further, they found that COVID-19 could lead to increased risks of blood clots and stroke. Out of the 100 myeloma patients, 9 had blood clots and D-dimer levels were significantly higher in patients with severe outcomes. 

Twenty-seven of the myeloma patients in the admitted group were treated with steroids and dexamethasone, which has subsequently shown to reduce mortality in hospitalized patients with COVID-19. A few patients in the group were treated with lopinavir-ritonavir, but clinical trials have yet to show a clinical benefit for this class of drug. 

The study authors note that myeloma patients can continue to minimize their risk of exposure by: 

• Using infusions, injections and oral drugs that favor fewer in-clinic visits
• Continue social distancing
• Continue wearing a mask
• Consider postponing stem cell transplant if possible