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Published on: July 15, 2015
Risk assessment and clinical implications of COVID-19 in multiple myeloma patients: A systematic review and
Sultan Mahmud1, Md Faruk Hossain2, Abdul Muyeed3
1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Introduction:
Patients with multiple myeloma (MM) face heightened infection susceptibility, particularly severe risks from COVID-19. This study, the first systematic review in its domain, seeks to assess the impacts of COVID-19 on MM patients.
Method:
Adhering to PRISMA guidelines and PROSPERO registration (ID: CRD42023407784), this study conducted an exhaustive literature search from January 1, 2020, to April 12, 2024, using specified search terms in major databases (PubMed, EMBASE, and Web of Science). Quality assessment utilized the JBI Critical checklist, while publication bias was assessed using Egger's test and funnel plot. The leave-one-out sensitivity analyses were performed to assess the robustness of the results by excluding one study at a time to identify studies with a high risk of bias or those that significantly influenced the overall effect size. Data synthesis involved fitting a random-effects model and estimating meta-regression coefficients.
Results:
A total of 14 studies, encompassing a sample size of 3214 yielded pooled estimates indicating a hospitalization rate of 53% (95% CI: 40.81, 65.93) with considerable heterogeneity across studies (I2 = 99%). The ICU admission rate was 17% (95% CI: 11.74, 21.37), also with significant heterogeneity (I2 = 94%). The pooled mortality rate was 22% (95% CI: 15.33, 28.93), showing high heterogeneity (I2 = 97%). The pooled survival rate stood at 78% (95% CI: 71.07, 84.67), again exhibiting substantial heterogeneity (I2 = 97%). Subgroup analysis and meta-regression highlighted that study types, demographic factors, and patient comorbidities significantly contributed to the observed outcome heterogeneity, revealing distinct patterns. Mortality rates increased by 15% for participants with a median age above 67 years. ICU admission rates were positively correlated with obesity, with a 20% increase for groups with at least 19% obesity. Mortality rates rose by 33% for the group of patients with at least 19% obesity, while survival rates decreased by 33% in the same group.
Conclusion:
Our meta-analysis sheds light on diverse COVID-19 outcomes in multiple myeloma. Heterogeneity underscores complexities, and study types, demographics, and co-morbidities significantly influence results, emphasizing the nuanced interplay of factors.
Insights
COVID-19 significantly impacts multiple myeloma (MM) patients, with high hospitalization (53%) and mortality (22%) rates. Factors like age and obesity influence outcomes, highlighting the need for tailored care.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Multiple myeloma (MM) patients exhibit increased susceptibility to infections, including severe COVID-19.
- This systematic review is the first to comprehensively assess COVID-19's impact on MM patients.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes of COVID-19 in patients with multiple myeloma.
- To identify factors contributing to heterogeneity in COVID-19 outcomes among MM patients.
Main Methods:
- Adherence to PRISMA guidelines and PROSPERO registration (CRD42023407784).
- Systematic literature search (Jan 2020–Apr 2024) across PubMed, EMBASE, and Web of Science.
- Quality assessment using JBI Critical checklist; publication bias assessed via Egger's test and funnel plot; random-effects model for data synthesis.
Main Results:
- Pooled hospitalization rate: 53% (I2=99%), ICU admission rate: 17% (I2=94%), mortality rate: 22% (I2=97%), survival rate: 78% (I2=97%).
- Significant heterogeneity observed across studies.
- Meta-regression revealed study types, demographics (age >67), and comorbidities (obesity) significantly influenced outcomes. Mortality increased by 15% in older patients and 33% in obese patients.
Conclusions:
- COVID-19 presents diverse outcomes in multiple myeloma patients.
- Heterogeneity in results is substantial, influenced by study design, patient demographics, and comorbidities.
- Findings underscore the complex interplay of factors affecting COVID-19 outcomes in MM, necessitating personalized management strategies.
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