In the COVID-19 era, oncologists have had to reimagine routine cancer care and follow-up care, especially for patients who are immunocompromised. Among the top priorities: finding the right balance between high-quality cancer treatment and limiting patients’ exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
For those managing patients with multiple myeloma (MM), the American Society of Hematology (ASH) recently provided guidance to help providers walk this fine line. Available on ASH’s website is a set of frequently asked questions (FAQs) and answers — updated July 21, 2020 (version 1.2) — to counsel physicians caring for patients with MM during COVID. Their recommendations include (but are not limited to): 1) individualizing treatment to reduce exposure, 2) switching to oral therapy whenever possible (eg, changing triple therapy to dual oral therapy in patients with stable disease and standard-risk cytogenetics), and 3) reducing clinic visits, which can be supported by the use of telemedicine, remote labs, and mailed prescriptions.1
But, even with the best preventive efforts, patients with MM remain susceptible to SARS-CoV-2 community transmission. Which begs the question: What effect does COVID-19 have on patients with MM? A recent paper from Mount Sinai hospital system in New York City provided some insight on the issue, reporting on characteristics of COVID-19 among patients with MM and their serological responses.2
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Lead author of the study Bo Wang, MD, hematology-oncology fellow, Icahn Mount Sinai School of Medicine, and principal investigator Deepu Madduri, MD, assistant professor of hematology and oncology, and director of clinical operations of multiple myeloma at Tisch Cancer Institute/Mount Sinai Hospital and Icahn School of Medicine, told Cancer Therapy Advisor in a joint statement why it was important for them to publish this retrospective study. “Beyond public health measures to protect our patients, we as physicians should be thinking about the specific factors that might place individual patients at risk and ways to mitigate the impact of COVID-19 for these patients,” they said.
In their study, Dr Wang and Dr Madduri evaluated various factors, including patient demographics, myeloma history, and current myeloma treatment regimens to determine if these variables increased the risk of hospitalization or death.2
Pulling data from electronic medical records, clinical charts, nursing records, lab results, and radiologic images, researchers identified 58 patients who were receiving treatment or follow-up care for MM within the Mount Sinai health care system and who were diagnosed with COVID-19 between March 1, 2020, and April 30, 2020.
A total of 22 participants received care for COVID at home, and 36 were hospitalized (23 at Mount Sinai, 13 at other institutions).2
Findings showed a significant association between the following factors and hospitalization: older age (>70 years), male sex, cardiovascular risk, and MM that was not in complete remission (CR) or stringent CR. In addition, hospitalized patients had elevated markers of inflammation (C-reactive protein, ferritin, D-dimer).2
“Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality,” the authors reported. Factors that were positively associated with mortality included elevated inflammatory markers, severe hypogammaglobulinemia, and non-White race. Mortality rates of patients with MM in this study (overall, 24%; Mount Sinai admissions, 30%; other institutions, 39%) were similar to the estimated mortality rates of others in the general population older than 45 years who had been hospitalized for COVID-19 in New York City (37% as of May 25, 2020). No deaths were reported in the outpatient population of this study.2
