Predictors of Hospitalizations and Death from COVID-19 in Patients with Multiple Myeloma

The COVID-19 (SARS-CoV-2) pandemic has led to unprecedented challenges in providing cancer care to patients all over the world. Compared to the general population, it is assumed that patients with hematologic malignancies are more susceptible to develop viral infections like COVID-19 and will experience more severe symptoms and complications given their immunocompromised status.

METHODS

This retrospective chart review included 57 patients who had multiple myeloma (MM), tested positive for COVID-19 and were hospitalized between 1/1/2020 until 5/1/2021. We report epidemiological, clinical, and laboratory characteristics along with outcomes.

RESULTS

57 MM patients were included in the study. The mean age of our cohort was 70.54 years with a standard deviation of 11.65, and 57.89% (n=33) patients were male. 45.61% (n=26) were non-smokers, 22.81% (n=13) were currently smokers and 31.58% (n=18) were former smokers. While the odds of hospitalization were not significantly increased with age (OR 1.03 95% CI 0.98-1.09, p=0.163), the odds of death were slightly increased with age, and the results were statistically significant (OR 1.07 95%1.00 -1.14, p=0.03). Race, ethnicity, gender and BMI, smoking status and flu/pneumovax vaccination did not have any effect on the odds of neither hospitalization nor death. Between all comorbidities that were present in our cohort, none significantly affected the odds of hospitalization. However, patients with heart failure had higher odds of death (OR 4.11 95% CI 0.98-17.22, p=0.05), and those with asthma had lower odds of death (OR 0.08 95% CI 0.009-0.67, p=0.02). Between all multiple myeloma subtypes, no specific subtype affected the odds of death, and only the light chain disease significantly reduced the odds of hospitalization (OR 0.11 95% CI 0.02-0.72, p=0.021). No specific medication or treatment regimen influenced the odds of hospitalization or death. As for pretesting biochemical parameters, elevated blood urea nitrogen significantly increased the odds of hospitalization (OR 1.08 95% CI 1.01-1.16, p=0.023), while elevated bilirubin decreased those odds (OR 0.19 95% CI 0.05-0.79, p=0.022). On the other side, elevated pretesting procalcitonin increased the odds of death (OR 3.77 95% CI 1.09-13.07, p=0.036), unlike elevated albumin levels that lowered the odds of death (OR 0.41 95% CI 0.19-0.84, p=0.015). On admission, elevated LDH was the only parameter that significantly increased the odds of death (OR 1.01 95% CI 1-1.02, p=0.024).

CONCLUSION

In a predominantly unvaccinated cohort, several demographic factors and comorbidities increased the risk of hospitalization and mortality. Elevated LDH, BUN, procalcitonin were linked with higher odds of mortality, nature of myeloma therapy and presence of immunoparesis did not influence outcomes. More data is required to understand the effect of COVID-19 in vaccinated patients with multiple myeloma and other hematologic malignancies. Some limitations of this dual center institution study are the small sample size.

Chaulagain:Sanofi/Zenzyme: Consultancy; Janssen Biotech: Consultancy, Speakers Bureau. Valent:Alexion, AstraZeneca Rare Disease: Research Funding.