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RESPONSE AND VACCINATION STATUS OR LACK OF IMMUNOPARESIS ARE ASSOCIATED WITH BETTER OUTCOME FOLLOWING COVID-19 INFECTION AMONG PATIENTS DIAGNOSED WITH MULTIPLE MYELOMA: A SINGLE CENTER EXPERIENCE ON 110 PATIENTS
HemaSphere ; 6(SUPPL 2):26, 2022.
Article in English | EMBASE | ID: covidwho-1915870
ABSTRACT

Introduction:

Patients with multiple myeloma (MM) have an inherently compromised humoral and cellular immunity predisposing to Covid-19 infection. Factors associated with increased risk of adverse COVID-19 outcome is unclear. The aim of our retrospective analysis was to evaluate COVID-19 infection outcome among our myeloma patients and to define the possible prognostic parameters. Patients And

Methods:

Between March 2020- February 2022, 10 myeloma patients were diagnosed with COVID infection confirmed by PCR test and computer tomography (CT). The severity of SARS-CoV-2 infection was classified according to WHO definition as mild symptomatic without pneumonia or hypoxia;moderate with or without signs of pneumonia with SpO2 >90% on room air;severe disease with symptoms of pneumonia and respiratory rate> 30/min, severe respiratory distress or SpO2 <90% on room air. Critical disease with acute respiratory distress syndrome (ARDS), sepsis and septic shock. In addition, CALL (comorbidity-age-lymphocyte count-lactate dehydrogenase) score was used. All patients were given supportive care including heparin and 0.4 gr/kg/day intravenous immunoglobulin for those presenting with immunoparesis regardless of IgG treshold of 4.0 gr/L. Convalescent or monoclonal plasma was not used. All anti-myeloma treatments were discontinued until full recovery.

Results:

Baseline characteristics of our patients are summarized in Table 1. The median age at onset of COVID-19 was 62 years. Three patients were therapy naive, two newly diagnosed MM and one with smoldering MM. At the time point of COVID-19 diagnosis, eight patients were being followed without treatment. Twenty patients were followed out-patient without any treatment and with full recovery. Eighteen (16%) patients were admitted to ICU and 13 (12%) required invasive mechanic ventilation. Two patients received hydroxychloroquine, 68 received favipiravir, one patient received anakinra and two patients received tocilizumab. Full recovery from COVID-19 infection with regression of clinic symptoms and achievement of PCR negativity of COVID-19 was observed in 93 (84.5%) patients and 17 (15.5%) patients died due to severe COVID-19 pneumonia with respiratory and multi-organ failure. No death due to thromboembolic event was observed. As expected, high CALL risk score (HR0.17 (95% CI 0.06-0.48) and higher COVID severity grade (HR0.26 (95% CI 0.07- 0.97) were detrimental. Age did not have an impact. However response <VGPR (HR 3.1 (95% CI 1.0-9.6);p=0.04) or immunoparesis (HR 6.59 (95% CI 1.44-30.1);p=0.01) were correlated (Kappa CE 0.212, p=0.03) and associated with worse COVID-19 outcome (Figure 1-2-3). In MVA with age, response, Call score, vaccine, immunoparesis entered in the model only immunoparesis was significant (HR 6.5, p=0.016). Mortality prior to introduction of vaccines reduced to 3.6 % compared with 11.8 % at the pre-vaccine period. There was a trend to increase in Covid infection incidence recently due to the Omicron variant.

Conclusion:

Among 110 MM patients, the mortality rate is less than the one reported by IMS during the beginning of the pandemic. In our experience COVID-19 infection severity and mortality decreases with anti-Covid vaccination, response ≥VGPR or lack of immunoparesis. Importantly, MM patients with COVID-19 infection need close monitoring for severe COVID-19-related complications, and correction of humoral immunity may be life-saving. .
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Topics: Vaccines Language: English Journal: HemaSphere Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Topics: Vaccines Language: English Journal: HemaSphere Year: 2022 Document Type: Article