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Published on: July 15, 2015
Infection risks in multiple myeloma: a systematic review and meta-analysis of randomized trials from 2015 to 2019
Nicole Balmaceda1, Muhammad Aziz2, Viveksandeep Thoguluva Chandrasekar3
1University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA. Nbalmaceda2@kumc.edu.
Background:
Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments.
Methods:
We performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs).
Results:
The risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection.
Conclusions:
This is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.
Insights
Patients with multiple myeloma face a persistent risk of severe infections and neutropenia throughout treatment. This risk is significant across all treatment phases and regimens, highlighting the need for better protective strategies.
Area of Science:
- Hematology
- Oncology
- Infectious Disease
Background:
- Multiple myeloma (MM) patients have elevated infection risks due to disease and treatments.
- Understanding infection and neutropenia risks is crucial for patient management.
Observation:
- A systematic review analyzed monthly risks of severe infection, pneumonia, and neutropenia in MM patients from randomized clinical trials (RCTs).
- Data was assessed across frontline, maintenance, and relapsed/refractory settings.
Findings:
- Severe infections (Grade III/IV), pneumonia, and neutropenia risks persist throughout MM treatment.
- No significant difference in these risks was found between frontline and relapsed/refractory settings.
- While low, risks in the maintenance setting were not negligible; three-drug regimens showed no increased risk over two-drug regimens.
Implications:
- This study quantifies infection and neutropenia risks in MM patients across treatment phases and regimens.
- Results emphasize the significant risk of severe infections and neutropenia in MM patients.
- Further research on antibiotic prophylaxis and other mitigation strategies is warranted to reduce morbidity and mortality.
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