COVID-19 infections and outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers

Patients with multiple myeloma have a compromised immune system, due to both the disease and anti-myeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in multiple myeloma patients treated at five large academic centers in New York City in the spring of 2020, during the time it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 multiple myeloma patients (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these 13 (17%) patients were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 non-admitted patients, four were asymptomatic. There was a higher risk of adverse outcome (ICU-admission, mechanical ventilation, or death) in Hispanic/Latinos (N=21), odds ratio (OR) 4.7 (95% confidence interval 1.3-16.7) and African American Blacks (N=33), OR 3.5 (1.1-11.5), as compared to White patients (N=36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated (Pg0.05) with adverse outcome: hypertension (N=56), OR 2.2 (0.9-5.4); diabetes (N=18), OR 0.9 (0.3-2.9); age g65 years (N=63), OR 1.8 (0.7-4.6); high dose melphalan with autologous stem cell transplant l12 months (N=7), OR 1.2 (0.2-5.4); IgGl650 mg/dL (N=42), OR 0.9 (0.3-2.2). In this largest cohort to date of patients with multiple myeloma and COVID-19, we found the case fatality rate to be 29% among hospitalized patients and that race/ethnicity was the strongest risk factor for adverse outcome.