“Sometimes, negative data can be really beneficial,” Drs Wang and Madduri told Cancer Therapy Advisor. “In this case, we found that none of the treatments that patients were on at the time of COVID-19 diagnosis were associated with poor outcomes. Additionally, patients who received stem cell transplants were not at increased risk of poor outcomes either. These are 2 of the things that really worried us as cancer care physicians because we did not want our standard management to negatively affect patients who might develop COVID-19.”

That said, lead author of the ASH FAQ document, S. Vincent Rajkumar, MD, who is Edward W. and Betty Knight Scripps Professor of Medicine, Mayo Clinic, Rochester, Minnesota, told Cancer Therapy Advisor that he is concerned with the mortality rates. “This study confirms the high mortality rate associated with COVID in patients with hematologic cancers. The mortality rate of 24% is strikingly high, because the denominator includes patients who were hospitalized as well as patients managed at home.”

Dr Rajkumar emphasized that patients with MM are vulnerable, and must take extra precautions to prevent SARS-CoV-2 infection, including social distancing, wearing masks, and proper hand hygiene. “I would also recommend that we continue to follow the ASH Myeloma COVID FAQs for management of myeloma — especially using oral medications when possible — and to limit the number of visits to hospitals,” he said.


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Mount Sinai was uniquely poised to collect data and analyze the effects of COVID-19 in patients with MM, given that the health care system’s average caseload of MM is about 3000 patients, and that the institution is located in New York City — the epicenter of the pandemic in the US during the course of the study.2

Among the 58 participants identified for this study, median patient age was 67 years. About half of the patients were female, and 63% of the people in the cohort were Black or people of color. The most common comorbidities reported were hypertension (64%), hyperlipidemia (62%), and obesity (37%). Median time between MM diagnosis and COVID-19 diagnosis was 30 months.At the time of COVID-19 diagnosis, nearly half of the patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0.2  

Patients had received a median of 1.5 lines of treatment, 17% of the cohort was on salvage therapy, and 41% of participants had previously undergone autologous stem cell transplant. All but 11 patients were receiving cancer treatment at the time of SARS-CoV-2 infection. Baseline disease status among the participants was complete response or stringent CR (CR or sCR; 26%), very good partial response (VGPR; 19%), partial response (PR; 22%), stable disease (SD; 3%), or progressive disease (PD; 16%).2

The study authors suggested this study can serve as a reference point for the identification of patients with MM who might be more vulnerable to SARS-CoV-2 infection and who may require early intervention to help mitigate catastrophic symptoms of COVID-19.2

The biggest takeaway from the study, according to Drs Wang and Madduri, is as follows: “While there may be further outbreaks or waves of COVID-19, as is occurring in the US at the moment, myeloma — and likely, other cancers — will continue to progress and harm patients, regardless. We should not reactively withhold myeloma-directed treatments from our patients out of fear or uncertainty, unless the patient has actively caught COVID-19.”

“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.”

References

  1. American Society of Hematology. COVID-19 and multiple myeloma: Frequently asked questions. Version 1.2; last updated July 21, 2020. Accessed August 3, 2020.
  2. Wang B, Van Oeklen O, Mouhieddine TH, et al. A tertiary center experience of multiple myeloma patients with COVID-19: Lessons learned and the path forward. J Hematol Oncol. 2020;13(1):94. doi:10.1186/s13045-020-00934-x