A global panel of experts convened by the International Myeloma Society has published consensus guidelines and recommendations for the prevention of infection in multiple myeloma, which remains the leading cause of morbidity and mortality in patients despite advances in treatment response.
The panel was asked to review existing literature and current guidelines from the Centers for Disease Control and Prevention, The Infectious Disease Society of America, and the National Comprehensive Cancer Network (NCCN), discuss topics related to infection risks and prevention of infectious complications in the context of emerging therapies, and provide recommendations for preventing such complications.
Broadly speaking, they concluded that the key to reducing the burden of infectious complications in this patient group is “an individualised treatment plan adapted by risk after comprehensive staging at diagnosis and relapse.”
The panel recommended optimising dose intensity in patients considered at high risk of severe infection and of clinically significant comorbidities, and considering the state of immunosuppression when treating a relapsed patient who has had multiple previous lines of therapy.
Key strategies for prevention of infection include ensuring that patients are vaccinated against common pathogens, with particular attention paid to the timing of vaccination, and also educating both patient and their carers about reducing exposure to sources of pathogens.
“Furthermore, we recommend risk-adapted antimicrobial prophylaxis and consideration of immunoglobulin replacement, and possibly myeloid growth factor support, in a small subset of patients,” the authors noted, and also suggested “careful surveillance during highly immunosuppressive therapies and after autologous HSCT” as this could help anticipate the chance and type of infection.
Outlining key features and recommendations in a paper published in The Lancet Haematology, the researchers highlighted that the periods of highest infectious risk are during the first three months following diagnosis and when treating relapsed or refractory multiple myeloma.