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

Abstract

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.

Risk Factors of Infection in Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide and Dexamethasone (Rd) Regimen: Real-Life Results of a Large Single-Center Study

“…Accordingly, anemia was reported as a factor predisposing to various types of infections in different MM patient groups. In a cohort of newly diagnosed MM patients, Lin et al found anemia (Hgb < 90 g/L) among advanced stage (ISS III) and elevated CRP to be risk factors associated with infection [ 31 ]. The occurrence of infection also contributed to inferior survival, such as factors influencing infection occurrence.…”

Risk Factors of Infection in Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide and Dexamethasone (Rd) Regimen: Real-life Results of a Large Single-center Study

“…Accordingly, anemia was reported as a factor predisposing to various types of infections in different MM patient groups. In a cohort of newlydiagnosed MM patients, Lin et al found anemia (Hgb <9.0 g/dl), among advanced stage (ISS III) and elevated CRP to be risk factors associated with infection [33]. The occurrence of infection also contributed to inferior survival, such as factors influencing infection occurrence.…”

The advanced lung cancer inflammation index predicts chemotherapy response and infection risk in multiple myeloma patients receiving induction chemotherapy

“…Given that NDMM patients have a high risk of infections at first admission, especially infections with Epstein‒Barr virus (EBV), hepatitis B virus (HBV) and Escherichia coli ( Lin et al, 2020 ), we excluded MM patients with concurrent infection from this study. Interestingly, our results highlight that ALI is not only an independent predictive marker of chemotherapy efficacy but also a predictor of susceptibility to infection in NDMM patients during induction chemotherapy.…”

“…Clinical evidence confirms that infections represent a major cause of morbidity and mortality in patients with MM, especially for those with severe infection, pneumonia, and neutropenia in relapsed/refractory settings ( Blimark et al, 2015 ; Balmaceda et al, 2021 ). In NDMM patients admitted for the first time, risk of infection correlates with poor prognosis, particularly in those with ISS stage III or low haemoglobin levels ( Lin et al, 2020 ). MM patients with a risk of infection and complications are recommended to receive optimal preventive strategies ( Bladé and Rosiñol, 2005 ; Raje et al, 2022 ).…”