Infection in multiple myeloma

Abstract

Infections are significant causes of morbidity and the leading cause of death in patients with MM. Therapeutic strategies impact differently on the immune system, predisposing patients to various opportunistic infections. Myeloma and treatment-associated organ dysfunctions and co-morbidities also increase the risk of infection. Prospective epidemiologic studies of infections of myeloma patients from six centers from Brazil and one from Chile were performed. A total of 228 infectious episodes (median of 1; range: 1-13) were observed in 156 patients during one year. Median age was 57 years (range: 33-89), and 112 were men. Seventy-one percent of episodes occurred in Stage III (Durie-Salmon). Patients were divided into three phases according to the time of occurrence of infection related to the treatment of myeloma: phase 1 = induction therapy, phase 2 = during HCT and phase 3 = maintenance therapy or in relapse. Active myeloma and renal failure were risk factors in Phase 1; respiratory tract infections (46%) and urinary tract infections (21%) were the most frequent. In Phase 2, the risk factors were central venous catheters, neutropenia and mucositis; bacteremia (31%) and fever of unknown origin (23%) were the most frequent characteristics. Patients who were receiving corticosteroids were more probable to suffer infections in Phase 3 the most common being respiratory tract infections (44%). Rates of infectious-related death were 14.5% in phase 1, 5% in phase 2 and 14% in phase 3 (P=NS). The introduction of novel life-prolonging therapies has transformed myeloma into a chronic disease. Resulting cumulative immunosuppression has increased the risk of infection and expanded the spectrum of potential pathogens in this patient population. Infections continue to represent a major challenge for clinicians caring for myeloma patients. Rev.

Herpetic Encephalitis Associated with Multiple Myeloma: Diagnostic Challenge

“…It has a progressive and incurable character, formed by B cells, characterized by the deregulated and monoclonal proliferation of plasmocytic in the bone marrow, which produce dysfunctional monoclonal immunoglobulin or fragments of M protein [4]. In accordance with the case studied, Silva et al [3] report that myeloma predominates in adult men aged 50-60 years, with a mean age of 65 years, and although the literature shows a higher prevalence in blacks, some studies show a higher prevalence in whites due to the pertinent characteristics of the studied population, [1][2][3][4][5] as was verified in the patient studied. Silva et al [4] further describe that the clinical manifestations of myeloma result from spinal neoplastic infiltration and the presence of the monoclonal protein in the blood and urine, so that the symptoms are variable: weight loss, bone pain, generalized fatigue and weakness, or be asymptomatic [4].…”

“…The appearance of new therapeutic options that prolong the life of the patients with this neoplasm led to an increase in the prevalence of the disease, attributing a chronic character to it. The management of such infections is based on the evaluation of the therapeutic risk for myeloma, considering factors related to the neoplasia and the host [2]. Regarding infections and the different risks promoted by the myeloma, encephalitis is one of the infections that can overlap and increase the morbimortality of the first, being considered the most serious infection caused by herpes simplex virus (HSV), also called herpes simplex virus.…”