Exploring nationwide trends in multiple myeloma (MM), autologous stem cell transplants (ASCTs), chimeric antigen receptor T-cell (CAR-T) therapy and coronavirus disease 2019 (COVID-19) in hospitalizations from 2017 to 2021.

Abstract

e19539 Background: MM represents approximately 17% of hematologic malignancies. Several new MM treatments have been approved over the years. This study explores trends in MM hospitalizations. Methods: This retrospective cross-sectional study utilizes the National Inpatient Sample data for 2017 to 2021. We included hospitalizations of adults with MM identified by ICD10 codes. We used chi-square test, Kruskal-Wallis H test, Cochran Armitage trend test and other tests as appropriate. The results are statistically weighted. Results: From 2017 to 2021, 598510 hospitalizations had a diagnosis of MM. Annual hospitalizations were 117040, 122325, 127140, 114410, and 117595 for 2017, 2018, 2019, 2020, and 2021 respectively. Results are reported chronologically. Median length of stay(LOS) was 5 days for all years. Median total hospitalization charges(TOTCHG) (in $) trended up: 44935, 46869, 49365, 53895, and 59447 (P<0.001). Inpatient Deaths (IPD) trended up: 5455 (4.7%), 5795 (4.7), 6175 (4.9), 6500 (5.7), and 7115 (6.1) (P<0.001). In 2020 and 2021, 1170 and 1665 deaths were COVID-19 positive. 5360 (4.7%) and 7690 (6.5) hospitalizations in 2020 and 2021 were COVID-19 positive. Treatment-associated pancytopenias trended up: 14350 (12.3%), 15710 (12.8), 15335 (12.1), 14615 (12.8) and 15525 (13.2) (P<0.001). Intensive Care Unit (ICU) requirements trended up: 5205 (4.4%), 5920 (4.8), 6135 (4.8), 6610 (5.8) and 6420 (5.5) (P<0.001). Hypogammaglobulinemia (HG) trended up: 1970 (1.7%), 2290 (1.9), 2605 (2.0), 2205 (1.9) and 2570 (2.2) (P<0.001). Transfusions trended down: 21210 (18.1%), 20145 (16.5), 19755 (15.5), 18795 (16.4) and 18885 (16.1) (P<0.001). Pathologic fractures remained stable at 1.1% (6415 over 5 years). Hospitalizations for ASCTs trended up: 6185, 6625, 6410, 6425, and 6415 (P = 0.011). IPD during ASCT remained stable: 60 (1%), 50 (0.8), 50 (0.8), 40 (0.6), and 60 (0.9) (P = 0.586). In 2020 and 2021, 5 and 20 deaths were COVID-19 positive (P<0.001). 15 (0.2%) and 45 (0.7) ASCT hospitalizations were COVID-19 positive in 2020 and 2021. The median LOS for ASCT was 16 days. Median TOTCHG ($) stayed relatively stable: 168602, 164636, 169490, 165354, and 168591. In 2021, 145 hospitalizations noted administration of CAR-T therapy. IPD was 0.COVID-19 positivity was 0. Median LOS was 10 days. Median TOTCHG was $1700293. Conclusions: With newer treatments, MM outcomes have improved. Outcomes in hospitalized MM patients present a more complex picture, as demonstrated by rising IPD, ICU, and HG. TOTCHG trended up for MM but was stable for ASCT. LOS remained stable. Transfusion requirements declined over time. These results may represent the impact of COVID-19 and of newer treatments, requiring higher-acuity care.