Jing Cao, PhD, DABCC, FADLM, Associate Professor, Director of Clinical Chemistry, Department of Pathology, University of Texas Southwestern Medical Center
Ruifang Zheng, MD, PhD, Staten Island University Hospital, formerly at University of Texas Southwestern Medical Center
Dr. Jing Cao and her colleagues from University of Texas Southwestern Medical Center have recently reported a study on how COVID-19 plays a role in the management of patients with multiple myeloma (MM). The study includes data from a single center and a review of published literature, with an emphasize on understanding the impact of MM treatment, neutralizing antibody drug and serological responses on patient outcomes to guide risk stratification and ensure the appropriate management of MM patients with COVID-19.
The study population includes 34 MM patients, with a median age of 61 (range: 35–82 years), who were tested positive for SARS-CoV-2 between 1 March 2020–15 August 2021. The study aimed at examining the effect of chemotherapy, the benefit of neutralizing monoclonal antibody (Bamlanivimab) and the impact of anti-CD38 monoclonal antibody (Daratumumab) on the hospitalization and mortality of the patients, as well as the efficacy of seroconversion.
The results showed increased hospitalization and mortality rates from COVID-19 in MM patients in comparison to the general population, especially for those on active chemotherapy. Other independent predictors of adverse outcomes include advanced age, high-risk myeloma, renal disease and suboptimal disease control. The use of daratumumab, one of the most common monoclonal antibody drugs for MM patients, was found to have no significant impact on disease severity or hospitalization. Additionally, the study revealed that decreased mortality was associated with the use of neutralizing monoclonal antibody drug. Lastly, the authors discussed their finding, in alignment with other published studies, that MM patients have a lower rate of serological responses to SARS-CoV-2 virus from either infection or vaccination. On the other hand, treatment with daratumumab did not show significant difference in seropositivity among MM patients.
In summary, the study concludes that MM patients have increased hospitalization and mortality rate due to COVID-19, and close monitoring, including testing of neutralizing antibody, is crucial to allow more proactive management of COVID-19 in MM patients and to achieve optimal outcomes in this vulnerable patient population.
多发性骨髓瘤患者感染 SARS-CoV-2后的风险分级
德克萨斯大学西南医学中心的曹静博士和她的同事最近报告了一项关于 COVID-19 如何影响多发性骨髓瘤 (MM) 患者治疗的研究。该研究通过单一中心数据分析和对已发表文献的回顾，旨在了解多发性骨髓瘤治疗、中和抗体药物和血清学反应对患者愈后的影响，以指导风险分级并确保对合并COVID-19感染的MM患者进行适当的管理。
该研究包括了34 名 MM 患者，中位年龄为 61 岁（范围：35-82 岁），他们在 2020 年 3 月 1 日至 2021 年 8 月 15 日期间SARS-CoV-2 呈阳性。该研究旨在检验化疗的效果、中和单克隆抗体（Bamlanivimab）的效益和抗CD38单克隆抗体（Daratumumab）对患者住院率和死亡率的影响, 以及SARS-CoV-2血清转换的效率。
该研究结果显示，与一般人群相比，MM患者因 COVID-19 住院的比例和死亡率有所增加，特别是对于那些正在接受化疗的患者。不良愈后的其他独立预测因素还包括高龄、高危骨髓瘤、肾脏疾病和MM控制不佳。Daratumumab是MM患者最常用的单克隆抗体药物之一。研究显示其对疾病严重程度或住院治疗的影响并不显著。此外，研究表明死亡率降低与中和单克隆抗体药物的使用有关。最后，作者讨论了他们的发现，与其他已发表的研究一致，即MM患者对 SARS-CoV-2 病毒的血清学反应率较低, 无论是感染还是接种疫苗。另一方面，Daratumumab治疗对 MM 患者的血清阳性率并没有表现出显著差异。
综上所述，该研究的结果表明，COVID-19可增加MM患者的住院率和死亡率，密切监测（包括中和抗体测试）对于这个脆弱群体至关重要， 这可以促进积极主动的 COVID-19 管理，从而对MM患者实现最佳治疗结果。
Reference:
Zheng R, Mieth K, Bennett C, Miller C, Anderson LD Jr., Chen M, Cao J. Clinical Features and Risk Stratification of Multiple Myeloma Patients with COVID-19. Cancers. 2023; 15(14):3598. https://doi.org/10.3390/cancers15143598