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Practical guidance on the prevention and management of infection in multiple myeloma patients: A case-based approach
A Kannan1, K Jeffrey2, S Misbah3
1Medical Sciences Division, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, Headington OX3 9DU, United Kingdom.
Abstract:
The risk of infection in multiple myeloma patients is significant, due to immune dysfunction secondary to myeloma, immunosenescence and age-related comorbidities, given the elderly myeloma patient demographic. Newer treatments, despite providing unprecedented improvements in disease-control, have further elevated infection risk. This risk is so substantial that we are approaching a period where a subset of older myeloma patients may be more likely to die secondary to infectious complications imposed by redirected T-cell therapy rather than from myeloma. As a result, it is essential to provide myeloma patients with the appropriate prophylaxis and monitoring against infection. In this review, we discuss disease-related, patient-related and treatment-related reasons for the increased infection risk in myeloma patients, and how to both prevent and manage this risk through creating a dynamic, infection prevention plan that is personalised to the individual patient.
Insights
Multiple myeloma patients face significant infection risks due to their condition, age, and advanced treatments. Proactive infection prevention and monitoring are crucial for managing this heightened vulnerability.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Multiple myeloma (MM) patients exhibit profound immune dysfunction, exacerbated by immunosenescence and comorbidities in an elderly demographic.
- Novel MM therapies, while improving disease control, paradoxically increase the risk of severe infections.
- Infection-related mortality is a growing concern, potentially surpassing myeloma-related deaths in patients undergoing advanced therapies like T-cell redirection.
Purpose of the Study:
- To review the multifaceted reasons behind the elevated infection risk in multiple myeloma patients.
- To outline strategies for preventing and managing infections in this vulnerable population.
- To emphasize the need for personalized infection prevention plans.
Main Methods:
- Review of existing literature on infection risk factors in multiple myeloma.
- Analysis of disease-related, patient-related, and treatment-related factors contributing to infections.
- Discussion of current prophylaxis and monitoring guidelines.
Main Results:
- Identified immune dysfunction, age, comorbidities, and intensive treatments as key drivers of infection risk.
- Highlighted the increasing threat of infectious complications from novel therapies.
- Emphasized the inadequacy of generalized approaches to infection control.
Conclusions:
- A dynamic, individualized infection prevention and management plan is essential for multiple myeloma patients.
- Prophylaxis and vigilant monitoring are critical to mitigate infection risks.
- Addressing infection risk is paramount for improving outcomes in multiple myeloma care.
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