Clinical Features and Risk Stratification of Multiple Myeloma Patients with COVID-19

SIMPLE SUMMARY: This study is about how COVID-19 affects patients with multiple myeloma (MM), a type of cancer, and aims to provide guidance for managing their risk and treatment. Authors reviewed published data and analyzed the medical records of 34 MM patients who tested positive for the SARS-CoV-2 virus in order to study the impact of chemotherapy and antibody drugs on hospitalization and death rates, as well as patients’ ability to produce antibodies. The findings revealed that MM patients have a higher risk of hospitalization and death from COVID-19, particularly those undergoing active chemotherapy. Older age, high-risk myeloma, renal disease, and poor disease control are predictors of worse outcomes. The use of daratumumab did not worsen the disease or increase hospitalization rates, and neutralizing antibodies were associated with reduced mortality. The study suggests that testing for neutralizing antibodies after COVID-19 vaccination in MM patients is needed to manage their risk of contracting COVID-19. ABSTRACT: SARS-CoV-2 infection often results in a more severe COVID-19 disease course in multiple myeloma (MM) patients compared to immunocompetent individuals. The aim of this report is to summarize the clinical features of the MM patients with COVID-19 and the impact of MM treatment on outcomes to guide risk stratification and ensure the appropriate management of the patients. Serological responses in MM patients post-infection or -vaccination are also reviewed to better understand the strategy of prevention. Along with reports from the literature, we presented findings from a retrospective analysis of the clinical characteristics and outcomes of COVID-19 infection in MM patients in our institution. Study population includes 34 MM patients with a median age of 61 (range: 35–82 years) who tested positive for SARS-CoV-2 between 1 March 2020–15 August 2021. We examined the effect of chemotherapy, the benefit of neutralizing monoclonal antibody (Bamlanivimab) and the impact of anti-CD38 antibody (daratumumab) on the hospitalization and mortality of the patients, as well as the efficacy of native antibody production. Our results showed that MM patients have increased hospitalization and mortality rates from COVID-19 compared with that of general population, especially those on active chemotherapy. Advanced age, high-risk myeloma, renal disease, and suboptimal disease control are independent predictors of adverse outcomes. The use of daratumumab does not increase the disease severity/hospitalization or the post-infection/vaccination seropositivity of SARS-CoV-2. The neutralizing antibody decreases overall mortality. Evidence from the current study and previous publications suggest that testing of neutralizing antibody post-SARS-CoV-2 vaccination in MM patients may be needed in reducing COVID-19 risk.