Risk of infections in multiple myeloma in the era of novel agents

Dr Cecilie Blimark, haematologist at the Sahlgrenska University Hospital in Sweden summarized her extensive population-based investigation encompassing symptomatic MM patients from the Swedish Myeloma Registry, ensuring a robust 98% coverage within the cancer registry.

A cohort of 8,600 MM patients was meticulously tracked from 2008 to 2022 or until the time of death, and was systematically paired with 4 controls matching in terms of age, gender, and geographical region. The findings reveal a 5-fold increase in the risk of bacterial infections, a 7-fold increase in the risk of viral infections, and an 11-fold increase in the risk of fungal infections among MM patients. These augmented risks manifested in susceptibility to severe conditions such as septicemia, pneumonia, meningitis, pyelonephritis, endocarditis, as well as infections like herpes zoster, influenza, CMV, and COVID.

Furthermore, all documented infections were of clinical significance, with a likelihood of being underreported, indicating a potentially higher prevalence.

Approximately 30% of deaths occurring within one year post-diagnosis were attributed to infections. Thus, the concern extends beyond the mere incidence of infections in these patients; rather, the life-threatening ramifications pose a substantial challenge.

In light of these findings, forthcoming clinical guidelines ought to extend beyond the prevention of bacterial infections and also encompass strategies for mitigating the more severe viral and fungal infections, given their pronounced impact and heightened risk among MM patients.

Reference:

Blimark C, ASH 2023. #4696

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