Infections in Hospitalised Patients with Multiple Myeloma: Main Characteristics and Risk Factors

Valković, Toni; Gačić, Vedrana; Ivandic, Jelena; Petrov, B. N.; Dobrila-Dintinjana, Renata; Dadić-Hero, Elizabeta; Načinović-Duletić, Antica

doi:10.4274/tjh.2013.0173

Cited by 28 publications

(31 citation statements)

References 54 publications

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“…Candida albicans was the main pathogenic fungus, consistent with past reports [ 34 ]; however, the infection rate by fungi (5.0%) was lower than a reported rate in patients receiving antitumour therapy (12.3%). Here, viruses were the most common pathogens, mainly including EBV and HBV, in contrast to published research [ 13 , 33 , 35 , 36 ], which found that gram-negative bacteria were the leading pathogens and herpes zoster virus was the main pathogenic virus. Based on data on antitumour therapy in previous studies, chemotherapy can increase the risk of bacterial infection [ 13 ], and bortezomib can increase the risk of herpes zoster virus infection [ 16 , 17 , 37 ]; therefore, the difference in infection spectrum may be related to the therapeutic factors.…”

Section: Discussioncontrasting

confidence: 64%

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

et al. 2020

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Background Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time. Methods Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis. Results Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P = 0.040), more severe anaemia (Hb < 90 g/L, P = 0.044) and elevated CRP (> 10 mg/L, P = 0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM (P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis (P = 0.011), especially ISS stage III (P = 0.008) and lower haemoglobin level (P = 0.039). Conclusions Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.

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Section: Discussioncontrasting

confidence: 64%

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

et al. 2020

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“…Neutropenia is a relatively common side effect with many drugs used for MM treatment and increases the risk of infectious complications, especially if severe and prolonged (Palumbo et al , ; Dimopoulos et al , 2015a; Valkovic et al , ). The incidence of neutropenia was similar with IRd and placebo‐Rd (33% vs. 31%; including 18% vs. 18% grade 3, 5% vs. 6% grade 4), and was transient and cyclical in nature.…”

Section: Resultsmentioning

confidence: 99%

Management of adverse events associated with ixazomib plus lenalidomide/dexamethasone in relapsed/refractory multiple myeloma

Kumar

Moreau²,

Hari

et al. 2017

Br J Haematol

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SummaryThe oral proteasome inhibitor ixazomib is approved in the United States, European Union and other countries, in combination with oral lenalidomide and dexamethasone (Rd), for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on the global, randomised, double‐blind, placebo‐controlled Phase III TOURMALINE‐MM1 study of ixazomib‐Rd (IRd) versus placebo‐Rd in patients with relapsed/refractory multiple myeloma. IRd resulted in a significant improvement in progression‐free survival versus placebo‐Rd (median: 20·6 vs. 14·7 months; hazard ratio 0·74). Common toxicities observed more commonly with IRd versus placebo‐Rd were thrombocytopenia, nausea, vomiting, diarrhoea, constipation, rash, peripheral neuropathy, peripheral oedema and back pain; these were generally grade 1/2 in severity except for thrombocytopenia (19% vs. 9% grade 3/4), which appeared manageable and reversible, with no differences between arms in significant bleeding or dose discontinuations. No cumulative toxicities were observed, indicating the potential feasibility of long‐term IRd treatment. Safety data from TOURMALINE‐MM1 are reviewed and guidance for managing clinically relevant adverse events associated with IRd is provided. Most toxicities were manageable with supportive care and dose delays or reductions as needed. Clinicians should be aware of and understand these potential side effects to optimise and prolong patient benefit.

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“…In addition, respiratory disease was a common cause of death in Puerto Rico, but not among the top causes in the SEER population. The respiratory tract is a common site of infection in MM patients . In addition, in Puerto Rico, there is a high incidence of respiratory diseases likely due to environmental factors like fungal spores, which may partially explain the elevated rate of death from respiratory causes in this population specifically.…”

Section: Discussionmentioning

confidence: 99%

“…The respiratory tract is a common site of infection in MM patients. 28 In addition, in Puerto Rico, there is a high incidence of respiratory diseases likely due to environmental factors like fungal spores, 29 which may partially explain the elevated rate of death from respiratory causes in this population specifically. Future studies could investigate the influence of these co-morbid conditions on prognosis and cause of death in MM patients.…”

Section: Discussionmentioning

confidence: 99%

Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987–2013

Castañeda‐Avila

Ortiz‐Ortiz

Torres‐Cintrón

et al. 2019

Intl Journal of Cancer

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Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co‐morbid conditions may be of increasing importance to MM patients’ long‐term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age‐standardized temporal trends showed a decreased MM‐specific mortality rate among US SEER (annual percent change [APC] = −5.0) and Puerto Rican (APC = −1.8) patients during the study period, and particularly after 2003 in non‐Hispanic SEER patients. Temporal decline in non‐MM causes of death was also observed among US SEER (APC = −2.1) and Puerto Rican (APC = −0.1) populations. MM‐specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26‐year period. The most pronounced decreases in MM‐specific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.

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Infections in Hospitalised Patients with Multiple Myeloma: Main Characteristics and Risk Factors

Cited by 28 publications

References 54 publications

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

Management of adverse events associated with ixazomib plus lenalidomide/dexamethasone in relapsed/refractory multiple myeloma

Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987–2013

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