Predictors of Severe COVID-19 Infection, Mortality in Patients With MM, AL Identified

Their findings, say the researchers, offer useful insights into the outcomes and risks of severe disease and mortality in patients who have multiple myeloma (MM) or amyloidosis (AL) with underlying monoclonal gammopathy who contract COVID-19.

Although the incidence of COVID-19 among patients with multiple myeloma (MM) and amyloidosis (AL) is low, the risk of severe infection is considerable, found researchers of a new retrospective study published in American Journal of Hematology.

Among the 9000 medical records analyzed by the group, 2% of patients had COVID-19, of which 24% had severe infection and 5% died from that infection. Their findings, say the researchers, offer useful insights into the outcomes and risks of severe disease and mortality in patients with underlying monoclonal gammopathy who contract COVID-19.

“Patients with MM and a COVID-19 infection have a more prolonged course of illness with higher mortality, with CD38 [cluster of differentiation 38]– and BCMA [B-cell maturation antigen]–directed therapies being associated with increased severity of infections,” wrote the researchers. “There is a paucity of large studies in MM exploring these therapies as independent risk factors for severe disease and death while considering other medical comorbidities. In addition, vast majority of the studies that are currently available on COVID-19 and MM mainly include hospitalized patients, creating a selection bias.”

In the current study, the researchers assessed the outcomes of patients with COVID-19 visiting 3 Mayo Clinic locations between December 2019 and August 2021. Due to their study period, the researchers noted that their findings may not be generalizable to variants that occurred later, including Omicron.

Throughout the study period, 16 of the 72 hospitalized patients (22%) died. The researchers performed a multivariable analysis, finding that having comorbid cardiac disease (risk ratio [RR], 2.6; 95% CI, 1.1-6.5; P = .038] was the only independent risk factor for mortality. Meanwhile, being in remission was associated with a lower risk of mortality (RR, 0.4; 95% CI, 0.2-0.8; P = .008).

Having comorbid cardiac disease was also associated with an increased risk of being admitted to the intensive care unit (ICU) (RR, 4.1; 95% CI, 1.3-12.4; P = .014) and having severe COVID-19 (RR, 3.0; 95% CI, 1.5-6.4; P = .003).

Notably, CD38-targeted therapy, high-risk cytogenetics, immunoparesis, and renal disease were not significantly associated with an increased risk of mortality. However, receiving anti-CD38 treatment within 6 months of COVID-19 was associated with an increased risk of being admitted to the ICU (RR, 3.6; 95% CI, 1.2-10.5; P = .02).

Independent risk factors for being admitted to the ICU, which occurred among 10% of patients, also included having pulmonary disease (RR, 3.6; 95% CI, 1.1-11.6; P = .029), and independent risk factors for having severe COVID-19 also included being 65 years or older (RR, 2.3; 95% CI, 1.0-5.2; P = .049).

Of the 44 patients who had severe COVID-19, 41 (93%) were unvaccinated. Two of the 12 patients (17%) who were fully vaccinated developed severe COVID-19 compared with the 0% reported in the Pfizer and Moderna studies that led to their approval.

“However, it is important to note that the severe infection rate in unvaccinated patients in our study was 24%; much higher than the severe infection rate in the placebo groups of the vaccine trials (both < 0.5%),” explained the researchers. “This discrepancy is most likely due to the difference in study population (immunocompromised patients with monoclonal gammopathy, frequently with other systemic comorbidities vs general population), reasons for COVID-19 PCR [polymerase chain reaction] testing (mostly targeted testing in our study vs routine screening in the vaccine studies), as well as different timepoints in the COVID-19 pandemic and different vaccine efficacy rates against different SARS-CoV-2 strains.”

Reference

Ho M, Zanwar S, Buadi F, et al. Risk factors for severe infection and mortality in patients with COVID-19 in patients with multiple myeloma and AL amyloidosis. Am J Hematol. Published online October 13, 2022. doi:10.1002/ajh.26762

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