ABSTRACT
Infections are the most important cause of mortality in multiple myeloma (MM) patients. In the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic, known as COVID-19, hematologic malignancies represent an important risk factor for COVID-19- associated deaths. Based on this data, there are major concerns over the outcome of COVID-19-infected MM patients. Recently published data showed that MM patients seem to be associated with higher risk of poor COVID-19 outcomes, due to both cancer and chemotherapy- related immune dysfunctions. Old age, renal impairment and acquired thrombophilia can be considered as additional risk factors of poor prognosis of COVID-19 disease in MM patients. We hereby, report the retrospective data on the baseline characteristics and outcome of COVID-19 infection in MM patients, collected by the MM GIMEMA Lazio Group. Between February and December 2020, data from 56 patients with MM and SARS-Cov-2 infection were reported from 13 Italian centers. The highest rate (80%) of SARS-Cov-2 infections occurred in October and November. The patients were 32 male (57%) and 24 female (43%). Median age was 68 years (range 44-88). At the time of COVID-19 infection, 31 patients were newly diagnosed with MM (55%), with 27 patients receiving first-line therapy;22 patients experienced relapse (39%) and 3 patients were in follow-up (5.4%). Overall, 46 patients were on active MM treatment (82%), 5 patients had previously received therapy within the last 12 months (8.9%) and 1 patient had been off-therapy for more than 12 months (1.8%). The recurrent MM therapy was immunomodulatory (IMiDs)-based regimens (37%), followed by combination of IMiDs and proteasome inhibitors (PIs) (28%), PIs-based regimens (16%) and monoclonal antibody-based regimens (17%);1 patient received autologous stem cell transplant (2%). Patients were confirmed positive by Sars-Cov2- tests using RT-PCR obtained from nasopharyngeal swabs. Patients with symptomatic infections were 54 (96.4%);2 patients had no symptoms (3.6%). The most common symptoms were fever (43%), followed by coughing, anosmia, dysgeusia and rhinitis. Pneumonia became a complication in 38 cases (68%) and 12 patients showed acute respiratory distress syndrome (ARDS) (21%). Patients requiring hospitalization were 39 (70%). We focused on analyzing hospitalized patients. The COVID-19 therapies were heterogeneous with the most frequent therapy including a combination of high-dose steroids, low-molecular-weight heparin and antibiotics. Remdesivir was used in 7 patients (32%);while 5 patients required mechanic ventilation (23%). The combination therapy based on antipyretics, pre-emptive heparin, oral steroids and antibiotics was the most common approach for non-hospitalized patients (30%). One patient required outpatient oxygen therapy. Three patients recovered without any treatment (10%). We analyzed possible variables influencing hospitalization and outcome. Univariate analysis identified a positive correlation between pneumonia and hospitalization (p<0.001). Pneumonia and ARDS were correlated with worse outcomes (p=0.003 and p=0.045). Hospitalization (p=0.007) and active anti-MM treatment (p=0.014) were correlated with poor outcomes. Twenty-two patients (39%) died following COVID-19 infections. Our data confirms the high mortality rate in hospitalized MM patients with COVID-19. Further studies are warranted to identify high-risk MM patients and effective pre-emptive strategies.