I am almost hesitant to even start this post as all of us, whether we are multiple myeloma patients or not, have been more than inundated with COVID-19 news over the past ten months. However, an interesting article was just published in the Blood Cancer Journal that specifically focuses on the outcomes of hospitalized myeloma patients. What is special about this article is that the authors compared the outcomes of myeloma patients against the outcomes of non-cancer patients that were specifically selected to match the myeloma patient profiles. In specific, the comparison between the two patient groups (MM patients and non-cancer patients of 167 patients each), included the following parameters :
“ … contemporary, age-/sex-matched noncancer patients with COVID-19 admitted at six participating hospitals. Among MM and noncancer patients, median age was 71 years, and 57% of patients were male; 75 and 77% of patients, respectively, had at least one comorbidity. COVID-19 clinical severity was moderate–severe in 77 and 89% of patients and critical in 8 and 4%, respectively. Supplemental oxygen was required by 47 and 55% of MM and noncancer patients, respectively, and 21%/9% vs 8%/6% required noninvasive/invasive ventilation.”
This random patient selection was done to quantify, as much as possible, other factors that could impact clinical outcomes between the two patient groups, and to pin down, also as much as possible, the exact impact of myeloma. The authors note :
“To assure uniformity, the study focused solely on patients requiring hospital admission—we did not include MM patients who were treated as outpatients for COVID-19.”
The results are interesting, to say the least :
“Mortality was 50% higher in MM patients (34%) vs noncancer patients (23%). The main predictors of inpatient mortality for MM were male sex, age >65 years, renal disease, and active/progressive disease.” [emphasis added]
“… age >65 years and male sex emerged as two of the most important risk factors predicting inpatient mortality. Notably, and in contrast to noncancer COVID-19 populations, in which 75 years has been reported as the cutoff predicting peak risk of death, the mortality rate in MM did not differ above 65 years of age, suggesting that there are other factors intrinsic to MM that influence the outcome.” [emphasis added]
“…renal insufficiency [kidney ‘issues’] is a major hallmark of MM (one of the four myeloma-defining events); in the present series, its presence at hospital admission for COVID-19 emerged as the most important factor for survival.” [emphasis added] By contrast, hypertension [high blood pressure] turned out to be a not significant factor on overall patient survival statistics.
“… the presence of uncontrolled disease had a detrimental effect on survival and was one of the independent factors predicting outcome.” [emphasis added]
And we need to pause here a bit and reflect. There have been a number of articles published in the medical press over the past half year that there has been an increased incidence of cancer patients (and not just MM patients) delaying continued diagnosis and treatment due to a variety of ‘lockdown’ measures that we have all seen effected since the onset of the pandemic, with projected long term detrimental effects on the patient population.
The authors note :
“This would help explain the significantly higher mortality rate observed in patients diagnosed at the time of pandemic (January–April 2020), since in most their disease was not adequately controlled; it is well known that newly diagnosed patients have an elevated risk of mortality due to infectious complications in the first 3 months of treatment. The benefit of disease control (complete/partial response) in the context of COVID-19 would likewise explain the favorable outcome observed in patients who had previously received ASCT since most of them were in response.”
I recommend that, for those who wish to learn more about this study, you read the full article provided in the link in the first paragraph. The article is easy to read and understand and is not loaded with medical ‘mumbo-jumbo’ and only includes a bearable load of statistical methodology. The key is that you understand the implications for us, multiple myeloma patients. This paper is a firm reminder for all of us to be vigilant with respect to COVID-19 exposure.
The continued guidance from CDC/NIH regarding COVID-19 can be easily summarized as ‘Don’t do stupid things’, especially during the upcoming holiday season. This is especially true for recently diagnosed patients that are still in the early phases of treatment. All of us work too hard and have worked too hard to be in the place we’re at with our disease. There is no need to push things so we can become just another COVID-19 statistic.
about the author
I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find successful treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and two grandsons who are the ‘lights of our lives’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs. I am a firm believer that staying mentally active, physically fit, compliant to our treatment regimen and taking an active interest in our disease are keys to successful treatment outcomes.