Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set

Abstract

The primary cause of morbidity and mortality in patients with multiple myeloma (MM) is an infection. Therefore, there is great concern about susceptibility to the outcome of COVID-19-infected patients with MM. This retrospective study describes the baseline characteristics and outcome data of COVID-19 infection in 650 patients with plasma cell disorders, collected by the International Myeloma Society to understand the initial challenges faced by myeloma patients during the COVID-19 pandemic. Analyses were performed for hospitalized MM patients. Among hospitalized patients, the median age was 69 years, and nearly all patients (96%) had MM. Approximately 36% were recently diagnosed (2019-2020), and 54% of patients were receiving first-line therapy. Thirty-three percent of patients have died, with significant geographic variability, ranging from 27% to 57% of hospitalized patients. Univariate analysis identified age, International Staging System stage 3 (ISS3), high-risk disease, renal disease, suboptimal myeloma control (active or progressive disease), and 1 or more comorbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of COVID-19 diagnosis, nor other anti-MM treatments were associated with outcomes. Multivariate analysis found that only age, high-risk MM, renal disease, and suboptimal MM control remained independent predictors of adverse outcome with COVID-19 infection. The management of MM in the era of COVID-19 requires careful consideration of patient- and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising disease control through appropriate MM treatment. This study provides initial data to develop recommendations for the management of MM patients with COVID-19 infection.

Graphical abstract

Figure 1.

Patient origin, mortality, and associated risk factors. (A) Number of patients in the IMS COVID-19 data set with plasma cell disorders. (B) Overall (outpatient and hospitalized) COVID-19 death rates in the data set by contributing countries. (C) Predicted COVID-19 outcome for MM patients by age. (D) A forest plot for risk factors for MM patients from univariate analysis. HR, high risk; LCL, lower confidence level; PD, progressive disease; UCL, upper confidence level; UK, United Kingdom; USA, United States of America.