Clinical Features and Prognostic Indicators of Mortality in MM Patients with COVID-19

Overview

This study presents the first large case-series analysis of hospitalized multiple myeloma (MM) patients with SARS-CoV-2 infection, comparing their clinical characteristics and outcomes to a matched noncancer cohort. It identifies preadmission prognostic factors associated with in-hospital mortality, highlighting the impact of MM-specific features and comorbidities on COVID-19 severity.

Background

COVID-19, caused by SARS-CoV-2, has a highly variable clinical presentation and is associated with increased severity in older patients, males, and those with comorbidities. Multiple myeloma is a plasma cell malignancy characterized by impaired humoral and cellular immunity, increasing susceptibility to infections. MM treatments can further modulate immune function, influencing infection risk. Prior to this study, data on COVID-19 outcomes in MM patients were limited to small case series and lacked comparative analyses with noncancer patients.

Data Highlights

A total of 216 MM patients with confirmed SARS-CoV-2 infection were reported from 73 centers between March and April 2020. After exclusions, data from hospitalized MM patients were analyzed alongside an age- and sex-matched noncancer COVID-19 cohort from six hospitals. Clinical, laboratory, treatment, and outcome variables were collected and analyzed using logistic regression to identify mortality predictors.

Key Findings

• MM patients exhibit a high susceptibility to severe COVID-19 due to impaired humoral and cellular immunity and treatment-related immunosuppression.
• Hospitalized MM patients with COVID-19 have distinct clinical characteristics compared to noncancer patients, including higher rates of cytopenias and immunosuppressive therapy exposure.
• Preexisting comorbidities and MM disease status significantly influence in-hospital mortality risk.
• Specific MM treatments, such as corticosteroids and proteasome inhibitors, may modulate infection severity and outcomes.
• Logistic regression models identified preadmission factors that predict mortality, with good calibration and discrimination validated by bootstrapping.

Clinical Implications

Clinicians should recognize the heightened risk of severe COVID-19 in MM patients, particularly those with active disease and comorbidities. Treatment regimens may need adjustment to balance myeloma control with infection risk during the pandemic. Early identification of high-risk patients can guide intensified monitoring and therapeutic interventions to improve outcomes.

Conclusion

This comprehensive national case-series provides critical insights into the clinical course and prognostic indicators of COVID-19 in MM patients, underscoring the need for tailored management strategies in this vulnerable population.

References

1. Spanish Myeloma Collaborative Group 2020 -- Clinical Features and Prognostic Indicators of In-Hospital Mortality in Patients with Multiple Myeloma and SARS-CoV-2 Infection