Patients with multiple myeloma (MM), an age-dependent neoplasm of antibody-producing plasma cells, have compromised immune systems and might be at increased risk for severe COVID-19 outcomes. This study characterizes risk factors associated with clinical indicators of COVID-19 severity and all-cause mortality in myeloma patients utilizing NCATS’ National COVID Cohort Collaborative (N3C) database. The N3C consortium is a large, centralized data resource representing the largest multi-center cohort of COVID-19 cases and controls nationwide (>16 million total patients, and >6 million confirmed COVID-19+ cases to date). Our cohort included myeloma patients (both inpatients and outpatients) within the N3C consortium who have been diagnosed with COVID-19 based on positive PCR or antigen tests or ICD-10-CM diagnosis code. The outcomes of interest include all-cause mortality (including discharge to hospice) during the index encounter and clinical indicators of severity (i.e., hospitalization/emergency department/ED visit, use of mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)). Finally, causal inference analysis was performed using the Coarsened Exact Matching (CEM) and Propensity Score Matching (PSM) methods. As of 05/16/2022, the N3C consortium included 1,061,748 cancer patients, out of which 26,064 were MM patients (8,588 were COVID-19 positive). The mean age at COVID-19 diagnosis was 65.89 years, 46.8% were females, and 20.2% were of black race. 4.47% of patients died within 30 days of COVID-19 hospitalization. Overall, the survival probability was 90.7% across the course of the study. Multivariate logistic regression analysis showed histories of pulmonary and renal disease, dexamethasone, proteasome inhibitor/PI, immunomodulatory/IMiD therapies, and severe Charlson Comorbidity Index/CCI were significantly associated with higher risks of severe COVID-19 outcomes. Protective associations were observed with blood-or-marrow transplant/BMT and COVID-19 vaccination. Further, multivariate Cox proportional hazard analysis showed that high and moderate CCI levels, International Staging System (ISS) moderate or severe stage, and PI therapy were associated with worse survival, while BMT and COVID-19 vaccination were associated with lower risk of death. Finally, matched sample average treatment effect on the treated (SATT) confirmed the causal effect of BMT and vaccination status as top protective factors associated with COVID-19 risk among US patients suffering from multiple myeloma. To the best of our knowledge, this is the largest nationwide study on myeloma patients with COVID-19.
多发性骨髓瘤（MM）是一种与年龄相关的抗体生成浆细胞肿瘤，患者免疫系统受损，可能面临更高的重症COVID-19风险。本研究利用美国国家转化科学促进中心（NCATS）的国家COVID队列协作（N3C）数据库，分析了骨髓瘤患者中与COVID-19严重程度临床指标及全因死亡率相关的风险因素。N3C联盟是一个大型集中化数据资源，代表全国规模最大的多中心COVID-19病例及对照队列（总计>1600万患者，迄今>600万确诊COVID-19阳性病例）。我们的队列包含N3C联盟中经PCR/抗原检测阳性或ICD-10-CM诊断代码确诊COVID-19的骨髓瘤患者（住院及门诊患者）。研究终点包括首次就诊期间的全因死亡率（含转至临终关怀）及严重程度临床指标（即住院/急诊就诊、机械通气或体外膜肺氧合使用）。最终采用粗化精确匹配（CEM）与倾向评分匹配（PSM）方法进行因果推断分析。
截至2022年5月16日，N3C联盟包含1,061,748例癌症患者，其中26,064例为MM患者（8,588例COVID-19阳性）。COVID-19确诊平均年龄为65.89岁，46.8%为女性，20.2%为黑人种族。4.47%的患者在COVID-19住院后30天内死亡。总体生存概率在研究期间为90.7%。多因素逻辑回归分析显示，肺部与肾脏疾病史、地塞米松治疗、蛋白酶体抑制剂（PI）治疗、免疫调节剂（IMiD）治疗及严重查尔森合并症指数（CCI）与更高的重症COVID-19风险显著相关。而血液或骨髓移植（BMT）与COVID-19疫苗接种呈现保护性关联。进一步的多因素Cox比例风险分析表明，高/中度CCI水平、国际分期系统（ISS）中重度分期及PI治疗与更差的生存率相关，而BMT与COVID-19疫苗接种可降低死亡风险。最终，匹配样本的受治疗者平均处理效应（SATT）证实，BMT与疫苗接种状态是美国多发性骨髓瘤患者中降低COVID-19风险的核心保护性因果因素。据我们所知，这是目前全国范围内规模最大的COVID-19骨髓瘤患者研究。
肿瘤(癌症)患者之家