Antibiotic prophylaxis for patients with newly diagnosed multiple myeloma: Systematic review and meta‐analysis

Abstract

Objective Ascertain the benefit of prophylactic antibiotics for patients with newly diagnosed multiple myeloma (MM), given that clinical trials evaluating this have had conflicting results. Methods We performed a systematic review and meta‐analysis evaluating the use of prophylactic antibiotics in patients with MM and its impact on infection risk and mortality. Results Across three included studies, a total of 664 patients received antibiotics and 650 patients received no antibiotics. The overall incidence of infection within 3 months was lower for antibiotic group compared to placebo (18.4% vs 23.4%, RR: 0.79, 95% CI 0.62‐1.00, P = .05, I2 = 6.5%). There was no difference in mortality in the first 3 months (1.5% vs 3.5%, RR: 0.47, 95% CI 0.17‐1.27, P = .60, I2 = 28.1%). Conclusion Antibiotic prophylaxis for a finite duration can decrease the overall incidence of infection within the first 3 months following diagnosis. This does not lead to a decrease in mortality. Further data on antibiotic resistance patterns, toxicity, healthcare expenditures, and the impact of antibiotics on subsequent therapies can assist providers in helping make decisions on prophylactic antibiotics with their patients.

Monoclonal Antibodies and Antibody Drug Conjugates in Multiple Myeloma

“…Vaccine response in MM patients is generally impaired compared to healthy controls, but all patients are encouraged to get vaccines against common pathogens (including influenza, Streptococcus pneumoniae, and Haemophilus influenzae) that represent significant risk in MM. Any administered vaccine should not contain live attenuated virus [74,75]. Although there are currently no data available from prospective trials evaluating COVID-19 vaccine efficacy in MM patients, it is currently recommended to vaccinate all MM patients with any vaccine for COVID-19 because of the potential benefit of preventing severe disease in this vulnerable patient population [76].…”

Real‐world data on survival improvement in patients with multiple myeloma treated at a single institution over a 45‐year period

“…The increased survival observed over time is more likely related to the introduction of HDM‐ASCT in the last few decades of the past century and, more recently, the widespread use of PI and IMiDs, as well as improvements in supportive care, increased experience of specialized teams, and a trend for starting treatment earlier, in less advanced stages of disease 20,43,44 . Early diagnosis can artefactually increase the observed survival because of the lag time bias, but this seems not to have been the case in our patients because age at diagnosis did not decrease over time.…”

Practical Considerations for the Daratumumab Management in Portuguese Routine Clinical Practice: Recommendations From an Expert Panel of Hematologists

“…A randomized phase III trial has suggested the benefit of levofloxacin in this context, but with an unquantified risk of promoting resistance to quinolones (29). Additionally, a meta-analysis evaluating the impact of prophylactic antibiotics in MM patients described the value of prophylaxis in decreasing the overall incidence of infection as modest and concluded that current evidence does not show a decrease in mortality due to infection in this setting (30). Having this in mind, we recommend that antibiotic prophylaxis should be provided only for patients who had neutropenia (< 500 cells/mm 3 ) or an infection in a previous treatment cycle.…”