COVID-19 Infection and Multiple Myeloma

Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly
contagious disease that appeared in Wuhan, Hubei province of China in December 2019. It has
now spread to multiple countries through infected persons travelling mainly by air. Most of
the infected patients have mild symptoms including fever, fatigue and cough. But in severe
cases, patients can progress rapidly and develop the acute respiratory distress syndrome,
septic shock, metabolic acidosis and coagulopathy including a disseminated intravascular
coagulation (DIC).

Multiple myeloma (MM) is a mature B-cell malignancy largely affecting the older patient with
a median age at presentation of 70 years. The general performance status (PS) and the
presence of comorbidity can identify a group of patients with poor tolerance to treatment, as
well as risks of both bacterial and viral infection. MM patients have benefited significantly
from therapeutic developments, however, the host response biology of the older person,
coupled with a distinct disease biology overlay induces immune dysfunction. For example, the
impact of aging on the human immune system is well documented. In MM it has long-since been
understood that there is a spectrum of immune dysregulation, an important host factor
considered in the "Hallmarks of cancer" theory. In addition, the delivery of anti-MM therapy
includes immune modulating agents such as steroids, proteasome inhibitors and CD38-directed
therapy though not all immune modulation is necessarily detrimental.

As such, myeloma patients are considered a higher risk in the current pandemic with
SARS-COVID19. However, it is not clear whether this is actually the case, and the risk may
not be different to population in general. Equally it may be sub-groups of patients who are
at risk e.g. on treatment versus stable response (plateau), frailty. AS such, this proposal
aims to collect in an observational study, the outcomes of COVID19 infection in MM patients
across Europe.