A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward
Bo Wang, Oliver Van Oekelen, Tarek H Mouhieddine, Diane Marie Del Valle, Joshua Richter, Hearn Jay Cho, Shambavi Richard, Ajai Chari, Sacha Gnjatic, Miriam Merad, Sundar Jagannath, Samir Parekh, Deepu Madduri
Journal of Hematology & Oncology, doi:10.1186/s13045-020-00934-x
Background: The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the USA. Our institution has treated over 2000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York. Methods: We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020, and April 30, 2020. We report epidemiological, clinical, and laboratory characteristics including the persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes. Results: Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-White. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%), and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (> 70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly (p < 0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant (p < 0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-White race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. The median time to PCR negativity was 43 (range 19-68) days from initial positive PCR.
Supplementary information Supplementary information accompanies this paper at https://doi.org/10. 1186/s13045-020-00934-x. Additional file 1: Figure S1 . Evolution of selected inflammatory biomarkers in a subset of patients (n = 12) hospitalized at the Mount Sinai Hospital for which the data was available. Different measurements from the same patient are connected. A linear regression line is plotted for the subgroup of patients that survived (blue, n = 8) and died (red, n = 4), respectively.
Abbreviations
Funding There is no outside funding declared for this study.
Ethics approval and consent to participate This study was performed in accordance with the Declaration of Helsinki and International Conference on Harmonization Guidelines for Good Clinical Practice (IRB: GCO#: 11-1433).
Consent for publication Not applicable. Author details
Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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