Abstract
BackgroundPatients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments.MethodsWe performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs).ResultsThe risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection.ConclusionsThis is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.
Highlights
Patients with multiple myeloma (MM) remain at an increased risk of infection due to the immunosuppressive nature of the underlying disease process, as well as the ensuing treatments [1,2,3]
We performed a systematic review and meta-analysis evaluating the monthly risk of infection, pneumonia, and neutropenia in patients with myeloma on treatment enrolled in randomized clinical trials (RCTs)
We demonstrate that rates of grade III or higher infection, pneumonia, and neutropenia are clinically significant across frontline and Relapsed/refractory MM (RRMM) setting
Summary
Patients with multiple myeloma (MM) remain at an increased risk of infection due to the immunosuppressive nature of the underlying disease process, as well as the ensuing treatments [1,2,3]. Given the increased risks of severe morbidity and mortality, it is imperative to assess the degree of immunosuppression and risk of infection with different treatment regimens, across all phases of treatment. Such information is useful for patients and providers in the risk assessment and mitigation decision-making process. Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments
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