Epidemiology and Risks of Infections in Patients With Multiple Myeloma Managed With New Generation Therapies

Lim, Chhay; Sinha, Priyadarshini; Harrison, Simon; Quach, Hang; Slavin, Monica A; Teh, Benjamin W

doi:10.1016/j.clml.2021.02.002

Cited by 20 publications

(20 citation statements)

References 23 publications

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“…However, IMiDs-based therapy was not associated with an increased risk. 33 In our study, the use of IMiDs was associated with an increased risk for infections ( P = .003). Although we cannot entirely explain this finding, a lower use of antimicrobial prophylaxis in patients who received IMiDs might explain the observed outcome (trimethoprim-sulfamethoxazole prophylaxis was used in 27.1%, 47.8%, and 65.7% of patients on IMiDs, PIs, and PIs plus IMiDs, respectively, P < .001).…”

Section: Discussionmentioning

confidence: 51%

“…Data on the risk for infection with the use of IMiDs and PIs are conflicting. 4 , 5 , 15 , 33 Brioli et al 15 reported that use of IMiDs and PIs was not associated with a significantly increased risk of infection. Recently, a study reported that use of PIs-based therapy and increasing lines of therapy (> 4) were independently associated with an increased risk of infection.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and Risk Factors for the Development of Infectious Complications in Newly Diagnosed Multiple Myeloma: A Multicenter Prospective Cohort Study in Latin America

Bove

Riva

Vásquez

et al. 2022

JCO Global Oncology

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PURPOSE Infections are a significant cause of morbidity and mortality in patients with multiple myeloma (MM). In Latin America, data on infectious complications in this patient population are lacking. METHODS We conducted a prospective cohort study of patients with newly diagnosed MM (NDMM) in seven Latin American countries between June 2019 and May 2020. Patients with active disease, on active therapy, and with a follow-up of 6 months from the time of diagnosis were included. Our primary end point was the number of infectious events that required hospitalization for ≥ 24 hours. RESULTS Of 248 patients with NDMM, 89 (35.9%) had infectious complications (113 infectious events), the majority (67.3%) within the first 3 months from diagnosis. The most common sites of infection were respiratory (38%) and urinary tract (31%). The microbial agent was identified in 57.5% of patients with gram-negative bacteria (73.5%) as the most common pathogen. Viral infections were infrequent, and no patients with fungal infection were reported. In the multivariable analysis, diabetes mellitus (odds ratio [OR], 2.71; 95% CI, 1.23 to 6.00; P = .014), creatinine ≥ 2 mg/dL (OR, 4.87; 95% CI, 2.29 to 10.35; P < .001), no use of trimethoprim-sulfamethoxazole prophylaxis (OR, 6.66; 95% CI, 3.43 to 12.92; P < .001), and treatment with immunomodulatory drugs (OR, 3.02; 95% CI, 1.24 to 6.29; P = .003) were independent factors associated with bacterial infections. At 6 months, 21 patients (8.5%) had died, 47.6% related to infectious complications. CONCLUSION Bacterial infections are a substantial cause of hospital admissions and early death in patients with NDMM. Antibiotic prophylaxis should be considered to reduce infectious complications in patients with MM.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Epidemiology and Risk Factors for the Development of Infectious Complications in Newly Diagnosed Multiple Myeloma: A Multicenter Prospective Cohort Study in Latin America

Bove

Riva

Vásquez

et al. 2022

JCO Global Oncology

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“…Patients with multiple myeloma (MM) due to their multifactorial immunodeficiency have an elevated risk of infections caused by different etiological agents that constitute, in them, an important cause of morbidity and mortality [84][85][86]. Viruses have been shown, in recent studies, to be a frequent etiology of infections in patients with MM, particularly those affecting the respiratory tract [86,87].…”

Section: What Is the Situation Of Covid-19 In Patients With Multiple ...mentioning

confidence: 99%

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper

Bouza

Martı́n²,

Alés³

et al. 2022

Rev Esp Quimioter

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We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.

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“…In particular, PI and daratumumab induce the viral reactivation of herpes [ 64 , 65 , 66 ]. Importantly, increasing lines of therapy (>4) are associated with a sevenfold increased risk of infection [ 67 ].…”

Section: Immunosuppression and Infection Riskmentioning

confidence: 99%

Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma

Pozzi

Bari

Pecherstorfer

et al. 2021

Cancers

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Relapsed/refractory (RR) multiple myeloma (MM) patients are a fragile population because of prolonged drug exposure and advanced age. Preserving a good quality of life is of high priority for these patients and the treatment of disease- and treatment-related complications plays a key role in their management. By preventing and limiting MM-induced complications, supportive care improves patients’ outcome. Erythropoietin-stimulating agents and bisphosphonates are well-established supportive strategies, yet novel agents are under investigation, such as anabolic bone agents and activin receptor-like kinase (ALK) inhibitors. The recent dramatic changes in the treatment landscape of MM pose an additional challenge for the routine care of RRMM patients. Multidrug combinations in first and later lines increase the risk for long-lasting toxicities, including adverse cardiovascular and neurological events. Moreover, recently approved first-in-class drugs have unique side-effect profiles, such as ocular toxicity of belantamab mafodotin or gastrointestinal toxicity of selinexor. This review discusses current standards in supportive treatment of RRMM patients, including recommendations in light of the recent SARS-CoV-19 pandemic, and critically looks at the incidence and management of side effects of standard as well as next generation anti-MM agents.

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Epidemiology and Risks of Infections in Patients With Multiple Myeloma Managed With New Generation Therapies

Cited by 20 publications

References 23 publications

Epidemiology and Risk Factors for the Development of Infectious Complications in Newly Diagnosed Multiple Myeloma: A Multicenter Prospective Cohort Study in Latin America

Epidemiology and Risk Factors for the Development of Infectious Complications in Newly Diagnosed Multiple Myeloma: A Multicenter Prospective Cohort Study in Latin America

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper

Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma

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