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Unmasking Infection Risks in Multiple Myeloma: Insights from a Retrospective Analysis

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Multiple myeloma (MM) has witnessed significant therapeutic advancements through the introduction of proteasome inhibitors and immunomodulators, leading to improved treatment outcomes. However, infections remain a formidable challenge for MM patients. The objective of our research is to investigate the factors that can forecast infection risk in MM patients. In pursuit of this, we conducted a thorough retrospective examination of medical records from Kidwai Memorial Institute of Oncology, Bangalore, involving 145 MM patients. Out of the 145 patients analyzed, almost half (47.5%; n = 69) encountered at least one infection during the course of their disease. Respiratory-related infections were the most prevalent (76.2%), followed by urinary tract infections (10%) and instances of diarrhea (8.8%). Notably, gram-positive bacteria constituted the majority of identified causative organisms, accounting for 48.2% of isolated pathogens, while gram-negative bacteria comprised 37.9% of the isolated organisms. Most infections were observed either at the time of presentation or during the first month (40.5%). Overall mortality during the study period was 4.8% (n = 7). Infections contributed to 57.1% (n = 4 out of 7 deaths) of the mortality. Moreover, patients in advanced stages exhibited an elevated risk of infection at presentation. Infections remain a major cause of morbidity and mortality in patients with MM. Nearly half of MM patients experience an episode of infection during treatment.Gram-positive bacteria are the most common pathogens, with respiratory infections being the most common foci. Prompt identification and treatment of infections is essential, but can be challenging due to atypical or absent symptoms. Antibacterial prophylaxis is an important preventive strategy, but further research is needed to develop innovative approaches to infection prevention and targeted therapeutic interventions. We must strive to develop innovative approaches to infection prevention in MM patients. Also we need to advance our understanding of the interplay between infections and MM to improve quality of care and outcomes for these individuals. By addressing these challenges, we can aspire to offer MM patients a brighter and healthier future.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

MM:

Multiple myeloma

LDH:

Lactate dehydrogenase

ICU:

Intensive care unit

NDDM:

Newly diagnosed multiple myeloma

R ISS:

Revised international staging system

AKI:

Acute kidney injury

MRSA:

Methicillin resistent staphylococcus aureus

IMid:

Immunomodulators

PI:

Proteasome inhibitors

ONJ:

Osteonecrosis jaw

UTI:

Urinary tract infections

IMWG:

International myeloma working group

CART:

Chimeric antigen receptor therapy

EHA ESMO:

European hematology association /European society of medical oncology

References

  1. Brioli A, Klaus M, Sayer H, Scholl S, Ernst T, Hilgendorf I, Scherag A, Yomade O, Schilling K, Hochhaus A, Mügge LO (2019) The risk of infections in multiple myeloma before and after the advent of novel agents: a 12-year survey. Ann Hematol 4(98):713–722

    Article  Google Scholar 

  2. Augustson BM, Begum G, Dunn JA, Barth NJ, Davies F, Morgan G, Behrens J, Smith A, Child JA, Drayson MT (2005) Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002—medical research council adult leukaemia working party. J Clin Oncol 23(36):9219–9226

    Article  PubMed  Google Scholar 

  3. Blimark C, Holmberg E, Mellqvist UH, Landgren O, Björkholm M, Hultcrantz M, Kjellander C, Turesson I, Kristinsson SY (2015) Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients. Haematologica 100(1):107–13. https://doi.org/10.3324/haematol.2014.107714

    Article  PubMed  PubMed Central  Google Scholar 

  4. Anderson KC (2011) Pathogenesis of myeloma. Annu Rev Pathol 6:249–274

    Article  CAS  PubMed  Google Scholar 

  5. Ntanasis-Stathopoulos I, Terpos E, Dimopoulos MA (2019) Optimizing immunomodulatory drug with proteasome inhibitor combinations in newly diagnosed multiple myeloma. Cancer J 25(1):2–10

    Article  CAS  PubMed  Google Scholar 

  6. Teh BW, Harrison SJ, Pellegrini M, Thursky KA, Worth LJ, Slavin MA (2014) Changing treatment paradigms for patients with plasma cell myeloma: impact upon immune determinants of infection. Blood Rev 28(2):75–86

    Article  PubMed  Google Scholar 

  7. Kalambokis G, Theodorou A, Kosta P, Tsianos EV (2008) Multiple myeloma presenting with pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus: report of a case and literature review. Int J Hematol 87(5):516–519

    Article  PubMed  Google Scholar 

  8. Mohan M, Susanibar-Adaniya S, Buros A, Crescencio JCR, Burgess MJ, Lusardi K, Davies F, Morgan G, Vanrhee F, Zangari M, Schinke C, Thanendrarajan S, Kothari A (2019) Bacteremias following autologous stem cell transplantation for multiple myeloma: risk factors and outcomes. Transpl Infect Dis 21(2):e13052. https://doi.org/10.1111/tid.13052

    Article  CAS  PubMed  Google Scholar 

  9. Girmenia C, Raiola AM, Piciocchi A, Algarotti A, Stanzani M, Cudillo L, Pecoraro C, Guidi S, Iori AP, Montante B, Chiusolo P (2014) Incidence and outcome of invasive fungal diseases after allogeneic stem cell transplantation: a prospective study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Biol Blood Marrow Transplant 20(6):872–880

    Article  PubMed  Google Scholar 

  10. Gitman M, Vu J, Nguyen T, Chen C, Rotstein C (2020) Evaluation of a routine screening program with tuberculin skin testing on rates of detection of latent tuberculosis infection and prevention of active tuberculosis in patients with multiple myeloma at a Canadian cancer centre. Curr Oncol 27(3):246–250

    Article  Google Scholar 

  11. Lee SJ, Richardson PG, Sonneveld P, Schuster MW, Irwin D, San Miguel JF, Crawford B, Massaro J, Dhawan R, Gupta S, Anderson KC (2008) Bortezomib is associated with better health-related quality of life than high-dose dexamethasone in patients with relapsed multiple myeloma: results from the APEX study. Br J Haematol 143(4):511–519

    Article  CAS  PubMed  Google Scholar 

  12. Lim C, Sinha P, Harrison SJ, Quach H, Slavin MA, Teh BW (2021) Epidemiology and risks of infections in patients with multiple myeloma managed with new generation therapies. Clin Lymphoma Myeloma Leuk 21(7):444–450

    Article  PubMed  Google Scholar 

  13. Vesole DH, Oken MM, Heckler C, Greipp PR, Katz MS, Jacobus S, Morrow GR (2012) Oral antibiotic prophylaxis of early infection in multiple myeloma: a URCC/ECOG randomized phase III study. Leukemia 26(12):2517–2520

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Wood J, Raynes K, Higgins H, Dawkins B, Meads D (2019) Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Oncol 20(12):1760–1772

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Raje NS, Anaissie E, Kumar SK, Lonial S, Martin T, Gertz MA, Krishnan A, Hari P, Ludwig H, O’Donnell E, Yee A (2022) Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol 9(2):e143–e161

    Article  CAS  PubMed  Google Scholar 

  16. Terpos E, Engelhardt M, Cook G, Gay F, Mateos MV, Ntanasis-Stathopoulos I, van de Donk NW, Avet-Loiseau H, Hajek R, Vangsted AJ, Ludwig H (2020) Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN). Leukemia 34(8):2000–2011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Residents and Faculty of Department Medical Oncology, Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru for their various inputs toward writing the article.

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Authors and Affiliations

  1. Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India

    Linu Abraham Jacob, Sabeena K. Choudhary, M. C. Suresh Babu, Lokesh K N, A. H. Rudresha, L. K. Rajeev, Smitha C. Saldanha, Anup Hegde & Vivek B M

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  1. Linu Abraham Jacob
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  2. Sabeena K. Choudhary
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  3. M. C. Suresh Babu
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  4. Lokesh K N
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  5. A. H. Rudresha
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  6. L. K. Rajeev
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  7. Smitha C. Saldanha
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  8. Anup Hegde
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  9. Vivek B M
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Contributions

LAJ and SKC contributed to the conception of the study. LAJ, SB and SKC were responsible for the acquisition. SKC, LKN, RAH, RLK, SS drafted the work. AH, VBM performed the statistical analysis. LAJ and SBMC substantively revised it. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Linu Abraham Jacob.

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Declarations

Ethics approval and consent to participate obtained from Kidwai Memorial Institute of Oncology Medical Ethics Committee: No. KMIO/MEC/011/24.08.2021. Written informed consent was obtained from all the participants.

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The authors declare that they have no competing interests.

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Jacob, L.A., Choudhary, S.K., Babu, M.C.S. et al. Unmasking Infection Risks in Multiple Myeloma: Insights from a Retrospective Analysis. Indian J Hematol Blood Transfus (2024). https://doi.org/10.1007/s12288-024-01753-7

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