Hultcrantz Malin, Richter Joshua, Rosenbaum Cara A, Patel Dhwani, Smith Eric L, Korde Neha, Lu Sydney X, Mailankody Sham, Shah Urvi A, Lesokhin Alexander M, Hassoun Hani, Tan Carlyn, Maura Francesco, Derkach Andriy, Diamond Benjamin, Rossi Adriana, Pearse Roger N, Madduri Deepu, Chari Ajai, Kaminetzky David, Braunstein Marc J, Gordillo Christian, Reshef Ran, Taur Ying, Davies Faith E, Jagannath Sundar, Niesvizky Ruben, Lentzsch Suzanne, Morgan Gareth J, Landgren Ola
Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Blood Cancer Discov. 2020 Jul 30;1(3):234-243. doi: 10.1158/2643-3230.BCD-20-0102. eCollection 2020 Nov.
Patients with multiple myeloma have a compromised immune system, due to both the disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in patients with multiple myeloma treated at five large academic centers in New York City in the spring of 2020, during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these, 13 patients (17%) were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 nonadmitted patients, 4 were asymptomatic. There was a higher risk of adverse outcome (intensive care unit admission, mechanical ventilation, or death) in Hispanics/Latinos ( = 21), OR = 4.7 (95% confidence interval, 1.3-16.7), and African American Blacks ( = 33), OR = 3.5 (1.1-11.5), as compared with White patients ( = 36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated ( > 0.05) with adverse outcome: hypertension ( = 56), OR = 2.2 (0.9-5.4); diabetes ( = 18), OR = 0.9 (0.3-2.9); age >65 years ( = 63), OR = 1.8 (0.7-4.6); high-dose melphalan with autologous stem cell transplant <12 months ( = 7), OR = 0.9 (0.2-5.4); and immunoglobulin G <650 mg/dL ( = 42), OR = 0.9 (0.3-2.2). In this largest cohort to date of patients with multiple myeloma and COVID-19, we found the case fatality rate to be 29% among hospitalized patients and that race/ethnicity was the most significant risk factor for adverse outcome.
Patients with multiple myeloma are immunocompromised, raising the question whether they are at higher risk of severe COVID-19 disease. In this large case series on COVID-19 in patients with multiple myeloma, we report 29% mortality rates among hospitalized patients and identify race/ethnicity as the most significant risk factor for severe outcome.. .
多发性骨髓瘤患者由于疾病本身和抗骨髓瘤治疗，免疫系统受损，因此可能特别容易感染新型冠状病毒肺炎（COVID-19）。在此，我们报告了2020年春季在纽约市五个大型学术中心接受治疗的多发性骨髓瘤患者发生严重疾病的结局和危险因素，当时纽约市是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行的全球中心。100例被诊断为COVID-19的多发性骨髓瘤患者（男性占58%；中位年龄68岁）中，75例入院；其中，13例患者（17%）接受有创机械通气，22例患者（29%）死亡。25例未入院患者中，4例无症状。与白人患者（n = 36）相比，西班牙裔/拉丁裔患者（n = 21）发生不良结局（入住重症监护病房、机械通气或死亡）的风险更高，比值比（OR）= 4.7（95%置信区间，1.3 - 16.7），非裔美国黑人患者（n = 33）的OR = 3.5（1.1 - 11.5）。达到不良联合终点的患者炎症标志物和细胞因子激活水平总体较高。其他研究的危险因素均与不良结局无显著相关性（P>0.05）：高血压（n = 56），OR = 2.2（0.9 - 5.4）；糖尿病（n = 18），OR = 0.9（0.3 - 2.9）；年龄>65岁（n = 63），OR = 1.8（0.7 - 4.6）；自体造血干细胞移植后12个月内接受大剂量美法仑治疗（n = 7），OR = 0.9（0.2 - 5.4）；免疫球蛋白G<650 mg/dL（n = 42），OR = 0.9（0.3 - 2.2）。在迄今为止最大的一组多发性骨髓瘤合并COVID-19患者中，我们发现住院患者的病死率为29%，且种族/族裔是不良结局的最显著危险因素。
多发性骨髓瘤患者免疫功能低下，这引发了他们是否有更高的严重COVID-19疾病风险的问题。在这个关于多发性骨髓瘤患者COVID-19的大型病例系列中，我们报告了住院患者29%的死亡率，并确定种族/族裔是严重结局的最显著危险因素。
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