Risk factors and characteristics of blood stream infections in patients with newly diagnosed multiple myeloma

Chun-Teng Huang,Chun-Yu Liu,Ling-Ju Huang,Chia-Jen Liu,Jyh-Pyng Gau,Muh-Hwa Yang,Yuan-Bin Yu,Tzeon-Jye Chiou,Cheng-Hwai Tzeng,Han-Tsung Liu,Po-Shen Ko,Liang-Tsai Hsiao,Jin-Hwang Liu

doi:10.1186/s12879-016-2155-1

Abstract

BackgroundPatients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy. Infection is a major risk factor for early deaths among these patients. The impact of blood stream infections (BSI) on newly diagnosed myeloma patients has been less studied. We aimed to study the incidence and risk factors of BSI within 3 months after diagnosis of multiple myeloma in a tertiary referral center.MethodsBetween November 2002 and December 2008, consecutive patients with multiple myeloma in Taipei Veterans General Hospital were retrospectively enrolled. Characteristics of patients with or without BSI were collected. Possible factors associated with development of BSI were analyzed by Cox regression.ResultsThere were a total of 222 patients. The incidence of BSI within 3 months after diagnosis is 11.7%. The patients with BSI had poorer survival outcomes than those without (mortality rate: 50% vs. 20.9%, p < 0.001). Moreover, advanced International Staging System stage (stage III vs. I/II: odds ratio [OR] 2.69, p = 0.049) and poor Eastern Cooperative Oncology Group (ECOG) performance status (ECOG > 2 vs. ≤ 2: OR 3.58, p = 0.005) were the independent risk factors of BSI, whereas immunoglobulin deficiency and low absolute lymphocyte count were not associated with risk of BSI development.ConclusionsOur study highlights the characteristic of myeloma patients with BSI and the importance of disease and host factors on risk of BSI. Myeloma patients with risks of BSI should be properly managed to reduce early mortality.

Highlights

Patients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy
There was no statistical difference in gender, age, myeloma types, status of immunoglobulin deficiency, absolute lymphocyte count (ALC), and induction chemotherapy
We found that neither the type of monoclonal gammopathy nor severe non-myelomatous immunoglobulin deficiency was associated with risk of blood stream infections (BSI)

Summary

Introduction

Patients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy. Infection is a major risk factor for early deaths among these patients. The impact of blood stream infections (BSI) on newly diagnosed myeloma patients has been less studied. We aimed to study the incidence and risk factors of BSI within 3 months after diagnosis of multiple myeloma in a tertiary referral center. Auguston et al reported a incidence of 10% (299/3107) patients die within 60 days of diagnosis of MM, and the major cause of death are infection and renal failure [4]. Infection is common in patients with newly diagnosed multiple myeloma and can be the initial presentation and the leading cause of death. Pulmonary and urinary tract infection occur more frequently [7], and infection occurs as the presenting feature in about 15% of patients with MM, and is the

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