Zheng Ruifang, Mieth Kelsey, Bennett Christen, Miller Carol, Anderson Larry D, Chen Mingyi, Cao Jing
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Cancers (Basel). 2023 Jul 13;15(14):3598. doi: 10.3390/cancers15143598.
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.
与免疫功能正常的个体相比，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染在多发性骨髓瘤（MM）患者中往往导致更严重的2019冠状病毒病（COVID-19）病程。本报告的目的是总结COVID-19的MM患者的临床特征以及MM治疗对预后的影响，以指导风险分层并确保对患者进行适当管理。还回顾了MM患者感染后或接种疫苗后的血清学反应，以更好地理解预防策略。结合文献报道，我们展示了对本机构MM患者COVID-19感染的临床特征和预后进行回顾性分析的结果。研究人群包括34例MM患者，中位年龄为61岁（范围：35 - 82岁），他们在2020年3月1日至2021年8月15日期间SARS-CoV-2检测呈阳性。我们研究了化疗的效果、中和单克隆抗体（巴瑞替尼单抗）的益处以及抗CD38抗体（达雷妥尤单抗）对患者住院和死亡率的影响，以及天然抗体产生的疗效。我们的结果表明，与普通人群相比，MM患者因COVID-19导致的住院率和死亡率增加，尤其是那些正在接受积极化疗的患者。高龄、高危骨髓瘤、肾脏疾病和疾病控制不佳是不良预后的独立预测因素。使用达雷妥尤单抗不会增加疾病严重程度/住院率或SARS-CoV-2感染后/接种疫苗后的血清阳性率。中和抗体可降低总体死亡率。当前研究和既往出版物的证据表明，可能需要对MM患者进行SARS-CoV-2疫苗接种后中和抗体检测以降低COVID-19风险。
