The potential link between Covid-19 and multiple myeloma: A new saga

Abstract

Background: Covid-19 is considered a primary respiratory disease-causing viral pneumonia and, in severe cases, leads to acute lung injury and acute respiratory distress syndrome (ARDS). In addition, though, extra-pulmonary manifestations of Covid-19 have been shown. Furthermore, severe acute respiratory distress syndrome coronavirus type 2 (SARS-CoV-2) infection may coexist with several malignancies, including multiple myeloma (MM).

Methods: This critical literature review aimed to find the potential association between SARS-CoV-2 infection and MM in Covid-19 patients with underlying MM. Narrative literature and databases search revealed that ARDS is developed in both MM and Covid-19 due to hypercalcemia and proteasome dysfunction.

Results: Notably, the expression of angiogenic factors and glutamine deficiency could link Covid-19 severity and MM in the pathogenesis of cardiovascular complications. MM and Covid-19 share thrombosis as a typical complication; unlike thrombosis in Covid-19, which reflects disease severity, thrombosis does not reflect disease severity in MM. In both conditions, thromboprophylaxis is essential to prevent pulmonary thrombosis and other thromboembolic disorders. Moreover, Covid-19 may exacerbate the development of acute kidney injury and neurological complications in MM patients.

Conclusion: These findings highlighted that MM patients might be a risk group for Covid-19 severity due to underlying immunosuppression and most of those patients need specific management in the Covid-19 era.

Keywords: Covid-19; SARS-CoV-2; acute lung injury; acute respiratory distress syndrome; multiple myeloma.

Figure 1

Critical complications in multiple myeloma and Covid‐19

Figure 2

Activation of inflammatory signaling pathways in Covid‐19 and multiple myeloma: Nod‐like receptor pyrin 3 inflammasome, signal transducer and activator of transcription 3 (STAT3), mitogen‐activated protein kinase (MAPK), and phosphatidylinositol 3 kinase/Protein kinase BCD38, heat shock protein 90 (Hsp90), receptor activator of nuclear factor kappa‐Β (NF‐κB) ligand (RANKL), NF‐κB, IL‐6, Advanced glycation end‐products (AGEs), high mobility group box‐1 (HMGB‐1), mechanistic target of the rapamycin (mTOR), CD147.