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Published on: May 1, 2015
Infection incidence, timing, and predictors in newly diagnosed multiple myeloma: a real-world retrospective cohort
Ozlem Candan1, Narmin Naghizada2, Tekin Tuncel3
1Division of Hematology, Department of Internal Medicine, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye.
Background:
Infections are a leading cause of morbidity and mortality in multiple myeloma (MM), particularly during the induction phase. Identifying real-world infection patterns and predictors is crucial for guiding preventive strategies.
Methods:
This retrospective cohort study included 161 newly diagnosed MM patients who received standard induction therapy at a single tertiary center between 2016 and 2024. Clinical, laboratory, and infection-related parameters were analyzed, with infection during the first 6 months defined as the primary outcome and 12-months analyses as secondary outcomes.
Results:
Infections occurred in 50.9% of patients, with the highest incidence within the first 3 months (27.3%, p = 0.004). Pneumonia was the most common type (34.1%), and gram-negative bacteria, particularly Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa, were predominant. Antibiotic resistance to TMP-SMX and levofloxacin was observed in E. coli isolates. Multivariate analysis identified advanced ISS stage (OR: 3.83), diabetes mellitus (OR: 3.64), and chronic kidney disease (OR: 6.01) as independent predictors of infection (p < 0.05). Lymphocyte counts were significantly lower in febrile episodes (p = 0.040), suggesting a potential association with immune status, although this finding should be interpreted cautiously. Hospitalization was more common in patients with advanced ISS and kidney disease. No significant differences were found between induction regimens.
Conclusion:
Infections pose a significant burden during the first year of MM treatment, particularly in high-risk patients during early induction. Readily available clinical parameters can aid in early risk stratification. These findings support a risk-adapted approach to infection prevention based on clinical risk factors, particularly during the early phase of treatment.
Insights
Infections are common in multiple myeloma (MM) patients during induction therapy. Advanced ISS stage, diabetes, and kidney disease predict infection risk, guiding preventive strategies.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Infections are a major cause of illness and death in multiple myeloma (MM), especially during initial treatment.
- Understanding real-world infection patterns and risk factors is essential for developing effective prevention strategies.
Purpose of the Study:
- To investigate infection incidence, types, and predictors in newly diagnosed multiple myeloma patients during induction therapy.
- To identify clinical parameters for early risk stratification of infections in MM patients.
Main Methods:
- Retrospective cohort study of 161 newly diagnosed MM patients receiving standard induction therapy (2016-2024).
- Analysis of clinical, laboratory, and infection data, with infection within 6 months as the primary outcome.
- Multivariate analysis to identify independent predictors of infection.
Main Results:
- Infections occurred in 50.9% of patients, peaking in the first 3 months.
- Pneumonia was the most frequent infection, with gram-negative bacteria predominating.
- Advanced ISS stage, diabetes mellitus, and chronic kidney disease were independent predictors of infection.
Conclusions:
- Infections represent a substantial burden in the first year of MM treatment, particularly for high-risk patients early in induction.
- Clinical factors like ISS stage, diabetes, and kidney disease can facilitate early risk assessment.
- A risk-adapted approach to infection prevention, guided by clinical factors, is recommended for early MM treatment phases.
