Page 214 - 2022_02-Haematologica-web

Letters to the Editor
of SARS-CoV-2 infection compared to the general popula- tion. Furthermore, although rates of symptoms, hospital- ization, hospitalization in ICU and deaths were slightly higher than in controls, MGUS did not appear to repre- sent a risk for a poorer COVID-19 outcome. The only fac- tor associated with an increased risk of death was older age; however this was likely not related to the presence of MGUS, but rather to the well known predictive power of this clinical parameter for a worse outcome in the general population infected by SARS-CoV-2.9
Although, to the best of our knowledge, we conducted the largest study of SARS-CoV-2 infection in patients with MGUS, several limitations are present in our analy- sis. First, as with any observational retrospective study,
there could be unintentional patient selection bias: MGUS may be misclassified and, conversely, individuals may be unaware of its presence. Second, not all MGUS patients had a complete dataset and some laboratory findings were lacking. Finally, long-term outcomes of MGUS and COVID-19 infection should also be explored. Therefore, further data are needed to achieve greater generalizability of our findings.
Other questions, particularly the possibility of a sub- optimal response in people with MGUS to anti-SARS- CoV-2 vaccine (as observed in MM), possibly due to age and MGUS-related immune dysfunction, will be proba- bly soon addressed by ongoing studies. In this setting, preliminary data show that MGUS patients receiving
Table 1. Characteristics of patients with monoclonal gammopathies of undetermined significance versus controls and COVID-19 outcome.
Total, n.
Mean Age, years +/- SD (range)
Sex, n. (%) Male
Female Comorbidities, n. (%) *
no 1
2
≥3
Mean number, n. +/- SD (range)
Incidence SARS-CoV-2 infection (%)
COVID-19 outcome
Presence of symptoms, n. (%; 95% CI) Hospitalization, n. (%; 95% CI) Hospitalization in ICU, n. (%; 95% CI) Death due to COVID-19, n. (%; 95% CI)
MGUS subtype (available in 86 patients), n. (%) IgG
IgA
IgM Biclonal LC only
Immunoparesis (available in 68 patients) 0/1/2, n.
≥1 subclass (%)
MGUS risk (available in 47 patients)°, n. (%) 0 Low
1 Low-intermediate
2 High-intermediate
MGUS
91
65.6 +/- 13.3 (29-89)
42 (46.2) 49(53.8)
29 (31.9)
30 (32.9)
19 (20.9)
13 (14.3)
1.3 +/-1.3 (0-5)
6.2 **
54 (59.3; 48.5-69.5) 19 (20.9; 13.1-30.7) 10 (11.0; 5.4-19.3) 8 (8.8; 3.9-16.6)
63 (73.2) 5 (6.0)
9 (10.4) 8 (9.3)
1 (1.1)
55/10/3 13/68 (19.1)
22 (46.8) 22 (46.8) 3 (6.4)
Controls
182
65.2 +/- 13.4 (29-89)
80 (44) 102 (56)
50 (27.5) 59 (32.5) 64 (35) 9 (5)
1.2 +/- 0.9 (0-3) 5.8 §
102 (56.0; 48.5-63.4) 26 (14.3; 9.5-20.2) 16 (8.8; 5.1-13.9)
10 (5.5; 2.7-10.0)
NA
NA NA
P-value 0.734
0.796
0.684 1.000 0.125 0.148 0.844
0.454
0.604 0.166 0.560 0.301
*Comorbidities evaluated included cardiovascular disease,pulmonary disease,diabetes,and non-hematological cancers;** Incidence among 1,454 MGUS followed at our Institution; § Incidence among the entire population of the Apulia region (227.761 cases of SARS-CoV-2 infection in 3.926.931 inhabitants); ° Rajkumar et al. Blood 2005;106(3):812-7. MGUS: monoclonal gammopathies of undetermined significance; NA: not applicable; ICU: intensive care unit; LC: light chain; CI: confidence interval; SD: standard deviation
Table 2. Risk for death in COVID-19 monoclonal gammopathies of undetermined significance patients, adjusted for different clinical param- eters.
Determinants aOR
95% CI
0.20 - 3.00 0.78 - 0.99 0.04 - 1.91 0.26 - 17.7 0.11 - 37.8 0.31 - 2.56
P-value 0.700
0.035 0.193 0.474 0.641 0.262 0.473
Group (MGUS vs. controls)
Age (years)
Gender (Male vs. Female)
Presence of comorbidities (Yes vs. No) Number of comorbidities (1-2 vs. ≥3) IgM vs non-IgM
0.76 0.88 0.27 2.16 2.01 0.28 0.45
Immunoparesis (0 vs. ≥1)
MGUS: monoclonal gammopathies of undetermined significance; aOR: adjusted odds ratio; CI: confidence interval; IgM: immunoglobulin M.
0.05 - 3.98
556
haematologica | 2022; 107(2)