NS-64: Lessons learned: patient management and outcomes of Multiple Myeloma patients during the COVID-19 pandemic in New York City

Abstract

New York City (NYC) was an epicenter of COVID-19 pandemic in the United States during spring 2020. During March–May 2020, approximately 203,000 confirmed COVID-19 cases were reported among NYC residents including 54,211 (26.6%) known to have been hospitalized and 18,679 (9.2%) who died. NYC had a higher confirmed coronavirus case volume than any country in the world, besides the United States. Here, we discuss how advanced practitioners Providers (APPs) and Health Care Support Staff in the Multiple Myeloma (MM) program at Mount Sinai Hospital in NYC modified patient care guidelines during the COVID-19 pandemic in an effort to balance the need for social distancing and optimizing patient care. Cognizant of these key factors during the pandemic, oncology APPs, nurses, physicians, and staff at Mount Sinai convened to determine how patients should be best managed. Important considerations in addition to remission status and type of therapy (IV/SC or oral) included the patient’s performance status and chemotherapy oral adherence. Based on these, the group determined: (1) Newly diagnosed patients or relapsed patients with significant cytopenias who need parenteral therapy should continue with the current therapy, but the number of visits should be decreased to limit exposure to other HCPs. If the patient has had a good response to treatment, consider changing to an oral regimen. (2) Patients in remission (complete remission, very good partial remission) should consider switching therapy to an oral regimen (immunomodulatory agents, proteasome inhibitors, dexamethasone, and/or Histone deacetylase inhibitors). (3) Stem cell harvest and stem cell transplant should be delayed if the patient continues to respond to the current therapyOutcomesDuring this time we had 58 MM 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. Although several demographic factors and comorbidities increased the risk of hospitalization and mortality, myeloma therapy did not influence outcomes. In fact, survival was comparable to the overall population of New York during the pandemic. Our data supports the need to maintain proactive management of MM patients by balancing their need for therapy with the increased risk of hospitalization and death in a subset of MM patients with COVID-19.