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Tytuł:
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A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward.
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Autorzy:
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Wang B; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Van Oekelen O; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Mouhieddine TH; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Del Valle DM; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Richter J; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Cho HJ; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Richard S; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Chari A; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Gnjatic S; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Merad M; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Jagannath S; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Parekh S; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA.
Madduri D; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 10 East 102nd Street, 6th Floor, New York, NY, 10029, USA. .
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Źródło:
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Journal of hematology & oncology [J Hematol Oncol] 2020 Jul 14; Vol. 13 (1), pp. 94. Date of Electronic Publication: 2020 Jul 14.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: [London] : Biomed Central, 2008-
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MeSH Terms:
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Betacoronavirus*
Tertiary Care Centers*
Coronavirus Infections/*complications
Multiple Myeloma/*complications
Pneumonia, Viral/*complications
Agammaglobulinemia/mortality ; Agammaglobulinemia/pathology ; Aged ; COVID-19 ; Cohort Studies ; Coronavirus Infections/mortality ; Female ; Humans ; Immunocompromised Host ; Inflammation/mortality ; Inflammation/pathology ; Male ; Middle Aged ; Multiple Myeloma/immunology ; New York City/epidemiology ; Pandemics ; Pneumonia, Viral/mortality ; Retrospective Studies ; Risk Factors ; SARS-CoV-2
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References:
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Contributed Indexing:
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Keywords: COVID-19; Multiple myeloma; New York; Pandemic; SARS; SARS-Cov-2; Smoldering multiple myeloma
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Entry Date(s):
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Date Created: 20200716 Date Completed: 20200723 Latest Revision: 20240329
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Update Code:
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20240329
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PubMed Central ID:
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PMC7359431
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DOI:
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10.1186/s13045-020-00934-x
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PMID:
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32664919
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Background: The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the USA. Our institution has treated over 2000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York.
Methods: We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020, and April 30, 2020. We report epidemiological, clinical, and laboratory characteristics including the persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes.
Results: Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-White. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%), and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (> 70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly (p < 0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant (p < 0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-White race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. The median time to PCR negativity was 43 (range 19-68) days from initial positive PCR.
Conclusions: Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality. Mounting a severe inflammatory response to SARS-CoV-2 and severe hypogammaglobulinemia was associated with higher mortality. The majority of patients mounted an antibody response to SARS-CoV-2. These findings pave a path to the identification of vulnerable MM patients who need early intervention to improve outcomes in future outbreaks of COVID-19.
Update of: medRxiv. 2020 Jun 29;:. (PMID: 32577702)
Comment in: Postgrad Med. 2021 Aug;133(6):589-591. (PMID: 33541185)
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