MULTIPLE MYELOMA AND OTHER PLASMA CELL DISEASES

multiplemyelomawos

PREVENTION AND MANAGEMENT OF INFECTIONS IN MULTIPLE MYELOMA

Emine Merve Savaş1 Ömür Gökmen Sevindik2,3

1 Ankara Etlik City Hospital, Department of Hematology, Ankara, Türkiye
2İstanbul Florence Nightingale Hospital, Department of Hematology and Stem Cell Transplantation, İstanbul, Türkiye
3Demiroğlu Bilim University, Faculty of Medicine, Department of Hematology, İstanbul, Türkiye

Savaş EM, Sevindik ÖG. Prevention and Management of Infections in Multiple Myeloma. In: Sevindik ÖG, editor. Multiple Myeloma and Other Plasma Cell Dyscrasias. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.129-143.

ABSTRACT

Multiple myeloma (MM) is a hematologic malignancy associated with significant morbidity and mortality, with infections being one of the most common and serious complications. The risk of infections in MM arises from a combination of host-related factors, such as advanced age, comorbidities, and frailty; disease-related immune suppression affecting both innate and adaptive immunity, including decreased phagocytic function, hypogammaglobulinemia, and T-cell dysfunction; and treatment-related factors, with proteasome inhibitors primarily associated with viral reactivation and immunomodulatory drugs often causing neutropenia, thereby increasing the risk of bacterial infections. The spectrum of infectious agents in multiple myeloma varies depending on the treatment phase; the first 4-6 weeks are particularly high-risk for infections, with bacterial infections representing a significant concern during this period, while in relapsed/refractory myeloma patients, the spectrum shifts depending on the treatment agents used, with fungal infections and opportunistic microorganisms becoming prominent issues. Preventive strategies have proven effective in reducing the incidence and severity of infections in MM patients. Vaccinations are a cornerstone of infection prevention and include annual influenza vaccination, pneumococcal vaccination and recombinant varicella-zoster vaccination for herpes zoster virus prevention. Antimicrobial prophylaxis is tailored to patient risk levels, with levofloxacin recommended for high-risk bacterial infections during the first three months after diagnosis and acyclovir or valacyclovir essential for preventing herpes simplex and zoster virus. Intravenous immunoglobulin (IVIG) is also an effective infection prevention strategy for specific patient groups. Despite treatment advances, infections remain a leading cause of morbidity and mortality among MM patients, particularly in those with relapsed or refractory disease. Recently introduced treatment modalities, such as bispecific antibodies, have been associated with a high risk of infections, and prevention strategies for these therapies remain unclear. This highlights the need for further research to optimize infection prevention strategies and improve outcomes in this vulnerable patient group. A better understanding of the effects of MM on the immune system is crucial for personalizing prophylaxis and treatments, which is critical for enhancing survival rates. This review provides insights into recent studies on infections in MM treatment and the methods implemented for their prevention.

Keywords: MM; Infection; Vaccination for myeloma; IVIG; Antimicrobial prophylaxis

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