A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

DOI record: { "DOI": "10.1186/s13045-020-00934-x", "ISSN": [ "1756-8722" ], "URL": "http://dx.doi.org/10.1186/s13045-020-00934-x", "abstract": "<jats:title>Abstract</jats:title><jats:sec>\n<jats:title>Background</jats:title>\n<jats:p>The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the USA. Our institution has treated over 2000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York.</jats:p>\n</jats:sec><jats:sec>\n<jats:title>Methods</jats:title>\n<jats:p>We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020, and April 30, 2020. We report epidemiological, clinical, and laboratory characteristics including the persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes.</jats:p>\n</jats:sec><jats:sec>\n<jats:title>Results</jats:title>\n<jats:p>Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-White. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%), and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (&gt; 70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly (<jats:italic>p</jats:italic> &lt; 0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant (<jats:italic>p</jats:italic> &lt; 0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-White race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. The median time to PCR negativity was 43 (range 19–68) days from initial positive PCR.</jats:p>\n</jats:sec><jats:sec>\n<jats:title>Conclusions</jats:title>\n<jats:p>Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality. Mounting a severe inflammatory response to SARS-CoV-2 and severe hypogammaglobulinemia was associated with higher mortality. The majority of patients mounted an antibody response to SARS-CoV-2. These findings pave a path to the identification of vulnerable MM patients who need early intervention to improve outcomes in future outbreaks of COVID-19.</jats:p>\n</jats:sec>", "alternative-id": [ "934" ], "article-number": "94", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "31 May 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "3 July 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "14 July 2020" }, { "group": { "label": "Ethics approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 1, "value": "This study was performed in accordance with the Declaration of Helsinki and International Conference on Harmonization Guidelines for Good Clinical Practice (IRB: GCO#: 11-1433)." }, { "group": { "label": "Consent for publication", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "Not applicable." }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "A.C.: Advisory board and consulting fees from Amgen, Antegene, Celgene, Janssen, Karyopharm, Millennium/Takeda, Novartis Pharmaceuticals, Oncopeptides, Sanofi; research funding from Amgen, Celgene, Janssen, Millennium/Takeda, Novartis Pharmaceuticals, Pharmacyclics. S. J.: Advisory board and consulting fees from Celgene, Bristol-Myers Squibb, Janssen Pharmaceuticals and Merck. H. J. C: Employed by the Multiple Myeloma Research Foundation, advisory board and consulting fees from Genetech, Celgene, Bristol Myers Squibb, GlaxoSmithKline and received research funding from Takeda, Celgene, and Genetech. D. M.: Advisory board and consulting fees from Janssen, Celgene, Bristol Myers Squibb, Takeda, Legend, GlaxoSmithKline, Kinevant, and Foundation Medicine. B.W.: Consulting fees from Sanofi Genzyme. J. R.: Speaking fees from Celgene and Janssen, advisory board and consulting fees from Celgene, Janssen, Bristol Myers Squibb, Oncopeptides, Adaptive Biotechnologies, X4 Pharmaceuticals, Karyopharm, and Antegene. S. P.: Consulting fees from Foundation Medicine, research funding from Celgene and Karyopharm, supported by 1R01CA244899-01A1. All other authors declare no potential conflict of interest<b>.</b>" } ], "author": [ { "affiliation": [], "family": "Wang", "given": "Bo", "sequence": "first" }, { "affiliation": [], "family": "Van Oekelen", "given": "Oliver", "sequence": "additional" }, { "affiliation": [], "family": "Mouhieddine", "given": "Tarek H.", "sequence": "additional" }, { "affiliation": [], "family": "Del Valle", "given": "Diane Marie", "sequence": "additional" }, { "affiliation": [], "family": "Richter", "given": "Joshua", "sequence": "additional" }, { "affiliation": [], "family": "Cho", "given": "Hearn Jay", "sequence": "additional" }, { "affiliation": [], "family": "Richard", "given": "Shambavi", "sequence": "additional" }, { "affiliation": [], "family": "Chari", "given": "Ajai", "sequence": "additional" }, { "affiliation": [], "family": "Gnjatic", "given": "Sacha", "sequence": "additional" }, { "affiliation": [], "family": "Merad", "given": "Miriam", "sequence": "additional" }, { "affiliation": [], "family": "Jagannath", "given": "Sundar", "sequence": "additional" }, { "affiliation": [], "family": "Parekh", "given": "Samir", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-7305-9690", "affiliation": [], "authenticated-orcid": false, "family": "Madduri", "given": "Deepu", "sequence": "additional" } ], "container-title": "Journal of Hematology &amp; Oncology", "container-title-short": "J Hematol Oncol", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2020, 7, 14 ] ], "date-time": "2020-07-14T13:38:34Z", "timestamp": 1594733914000 }, "deposited": { "date-parts": [ [ 2021, 7, 14 ] ], "date-time": "2021-07-14T00:18:56Z", "timestamp": 1626221936000 }, "indexed": { "date-parts": [ [ 2024, 4, 2 ] ], "date-time": "2024-04-02T06:38:28Z", "timestamp": 1712039908806 }, "is-referenced-by-count": 94, "issue": "1", "issued": { "date-parts": [ [ 2020, 7, 14 ] ] }, "journal-issue": { "issue": "1", "published-print": { "date-parts": [ [ 2020, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2020, 7, 14 ] ], "date-time": "2020-07-14T00:00:00Z", "timestamp": 1594684800000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2020, 7, 14 ] ], "date-time": "2020-07-14T00:00:00Z", "timestamp": 1594684800000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1186/s13045-020-00934-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1186/s13045-020-00934-x/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1186/s13045-020-00934-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1186", "published": { "date-parts": [ [ 2020, 7, 14 ] ] }, "published-online": { "date-parts": [ [ 2020, 7, 14 ] ] }, "published-print": { "date-parts": [ [ 2020, 12 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "key": "934_CR1", "unstructured": "Richardson S, Hirsch JS, Narasimhan M, et al. 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