Executive summary of consensus clinical practice guidelines for the prevention of infection in patients with multiple myeloma

Abstract

Infection remains a significant contributor to morbidity and mortality in patients with myeloma. This guideline was developed by a multidisciplinary group of clinicians who specialise in the management of patients with myeloma and infection from the medical and scientific advisory group from Myeloma Australia and the National Centre for Infections in Cancer. In addition to summarising the current epidemiology and risk factors for infection in patients with myeloma, this guideline provides recommendations that address three key areas in the prevention of infection: screening for latent infection, use of antimicrobial prophylaxis and immunoglobulin replacement and vaccination against leading respiratory infections (severe acute respiratory syndrome coronavirus 2, influenza and Streptococcus pneumoniae) and other preventable infections. This guideline provides a practical approach to the prevention of infection in patients with myeloma and harmonises the clinical approach to screening for infection, use of prophylaxis and vaccination to prevent infectious complications.

Multiple Myeloma: A Review of the Literature and a Case Report Highlighting the Immunocompromised State of Myeloma Patients

“…This approach still awaits validation but holds great promise [ 39 ]. Ongoing research is required to further determine the value of approaches such as CAR-T cell therapy, monoclonal antibodies, bispecific antibodies or ADCs [ 40 ]. The goal of refining future approaches is to enhance patients’ immune responses while minimizing the risks associated with conventional treatments.…”

Infections following bispecific antibodies in myeloma: a systematic review and meta-analysis

“…In anticipation, pretreatment screening for hepatitis B and seropositivity for CMV, varicella zoster, and herpes simplex viruses should be performed to guide subsequent management. 29 Strong consideration should be given to routine herpes simplex and varicella zoster and PJP prophylaxis. A low threshold for investigating viral reactivation and dissemination, including adenovirus, CMV, and varicella should be considered.…”

“…Intravenous immunoglobulin is recommended with hypogammaglobulinemia and was associated with reduced rates of severe bacterial infections in a retrospective analysis. 24 , 29 , 30 Fixed-duration treatment with bispecific antibodies and/or response-adapted treatment should also be evaluated in clinical trials.…”