Survival in multiple myeloma and SARS‐COV‐2 infection through the COVID‐19 pandemic: Results from the EPICOVIDEHA registry

Abstract

Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2) infection and subsequent coronavirus (20)19 disease (COVID‐19)‐related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID‐19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS‐CoV‐2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world. Median follow‐up was 52 days for the entire cohort and 83 days for survivors. Three‐hundred and three patients died (24%) and COVID‐19 was the primary reason for death of around 89% of them. Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus unvaccinated, while only a trend favoring vaccinated patients was observed in subjects with responsive MM. Vaccinated patients with at least 2 doses showed a better OS than those with one or no vaccine dose. Overall, according to pandemic waves, mortality rate decreased over time from 34% to 10%. In multivariable analysis, age, renal failure, active disease, hospital, and intensive care unit admission, were independently associated with a higher number of deaths, while a neutrophil count above 0.5 × 109/L was found to be protective. This data suggests that MM patients remain at risk of SARS‐CoV‐2 infection even in the vaccination era, but their clinical outcome, in terms of OS, has progressively improved throughout the different viral phases of the pandemic.

Antibody response to breakthrough SARS-CoV-2 infection in “booster” vaccinated patients with multiple myeloma according to B/T/NK lymphocyte absolute counts and anti-CD38 treatments

“… 1 – 3 Notably, “booster” doses have been shown to enhance the humoral response of these patients. 4 – 7 We recently reported the greatly improved clinical outcome of breakthrough SARS-CoV-2 infection in MM patients who had received three or more doses of anti-SARS-CoV-2 vaccines during the different phases of the pandemic COVID-19 including the most recent viral variants of concern (VOCs); 8 , 9 most of the tested patients had developed an adequate antibody response (anti-spike IgG) to the virus. 9 Due to the scarcity of data about the role of different lymphocyte subsets in this specific population of patients, in the present study, we aimed to evaluate a possible relationship between antibody response after SARS-CoV-2 infection in “booster” vaccinated (at least 3 doses) MM patients and main circulating lymphocyte subpopulations.…”