Sample average treatment effect on the treated (SATT) analysis using counterfactual explanation identifies BMT and SARS-CoV-2 vaccination as protective risk factors associated with COVID-19 severity and survival in patients with multiple myeloma - Scorecard - MDSpire
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Sample average treatment effect on the treated (SATT) analysis using counterfactual explanation identifies BMT and SARS-CoV-2 vaccination as protective risk factors associated with COVID-19 severity and survival in patients with multiple myeloma
Clinical Scorecard: Analysis of Sample Average Treatment Effect on Treated (SATT) via Counterfactual Explanation Reveals Bone Marrow Transplantation and SARS-CoV-2 Vaccination as Protective Factors Against COVID-19 Severity and Survival in Multiple Myeloma Patients
At a Glance
Category
Detail
Condition
Multiple Myeloma patients with COVID-19 infection
Key Mechanisms
Compromised immune system due to malignant plasma cell proliferation, immunosuppression from therapies, and comorbidities increasing COVID-19 severity and mortality
Target Population
Multiple myeloma patients diagnosed with COVID-19 across US healthcare centers
Care Setting
Inpatient and outpatient clinical settings within multi-center healthcare systems contributing to the National COVID Cohort Collaborative (N3C)
Key Highlights
Multiple myeloma patients have increased risk of severe COVID-19 and higher inpatient mortality (34% higher) compared to non-cancer populations.
Bone marrow transplantation (BMT) and SARS-CoV-2 vaccination identified as protective factors reducing COVID-19 severity and mortality in myeloma patients.
Large-scale analysis of 26,064 myeloma patients (8,588 COVID-19 positive) from the N3C registry enables robust identification of risk and protective factors.
Guideline-Based Recommendations
Diagnosis
Identify multiple myeloma patients using SNOMED code 3633460000 within EHR data.
Confirm COVID-19 status based on N3C positive phenotyping guidelines within 30 days before and after diagnosis.
Assess International Staging System (ISS) for myeloma using albumin and beta-2 microglobulin levels.
Management
Consider bone marrow transplantation as a protective intervention against severe COVID-19 outcomes in eligible myeloma patients.
Promote SARS-CoV-2 vaccination to reduce COVID-19 severity and mortality risk in this vulnerable population.
Monitor and adjust anti-myeloma therapies carefully due to immunosuppressive effects that may increase COVID-19 risks.
Monitoring & Follow-up
Track COVID-19 severity and all-cause mortality within 30 days post diagnosis in myeloma patients.
Evaluate comorbidities using Charlson Comorbidity Index adjusted for cancer diagnosis to stratify risk.
Monitor for complications such as cardiovascular disease, renal impairment, lymphopenia, neutropenia, and venous thromboembolism.
Risks
Immunosuppression from myeloma and its treatments increases susceptibility to severe COVID-19 and post-acute sequelae.
Comorbid conditions common in myeloma patients exacerbate COVID-19 morbidity and mortality.
26,064 multiple myeloma patients with 8,588 confirmed COVID-19 cases from the N3C registry.
Bone marrow transplantation and SARS-CoV-2 vaccination are associated with reduced COVID-19 severity and mortality; anti-myeloma therapies require careful management due to immunosuppressive risks.
Clinical Best Practices
Utilize large multi-center EHR datasets like N3C for comprehensive risk assessment in myeloma patients with COVID-19.
Incorporate staging and comorbidity indices to guide individualized patient management.
Encourage vaccination and consider bone marrow transplantation status when evaluating COVID-19 prognosis.
Continuously monitor evolving SARS-CoV-2 variants and adapt clinical strategies accordingly.
by Amit Kumar Mitra, Ujjal Kumar Mukherjee, Suman Mazumder, Vithal Madhira, Timothy Bergquist, Yu Raymond Shao, Feifan Liu, Qianqian Song, Jing Su, Shaji Kumar, Benjamin A. Bates, Noha Sharafeldin, Umit Topaloglu
