Introduction

In the world of multiple myeloma (MM), the threat of infections casts a long shadow, significantly heightening mortality risks for patients. A recent comprehensive study published in Haematologica revealed some staggering statistics: patients with multiple myeloma are five times more susceptible to infections than the general population.

Background

Historically, treatments like chemotherapy, thalidomide, and cortisone have been the cornerstone of managing multiple myeloma. However, the landscape has evolved dramatically since the early 2000s, with newer therapies such as monoclonal antibodies (MoAbs), immunomodulatory drugs (IMiDs), and proteasome inhibitors (PIs) leading the charge against this aggressive cancer. Research from the so-called “chemotherapy era” indicated that infection risks could be up to seven times greater for these patients compared to those without the disease.

Infection Risks and Mortality

Infections have proven to be a leading cause of mortality, accounting for 22% of deaths within the first year post-diagnosis among multiple myeloma patients. In fact, other studies indicate that a staggering 45% of patients with MM may face early mortality due to infections. This highlights an urgent need for more up-to-date data to better understand the infection-related risks and their impact on multiple myeloma prognoses.

Study Overview

To delve deeper into this issue, researchers conducted a population-based study in Sweden, evaluating the frequency of infections and infection-related deaths among symptomatic multiple myeloma patients from 2008 to 2021. Utilizing data from the Swedish Myeloma Registry, the study included 8,672 diagnosed patients and 34,561 age-matched health controls.

Key Findings

Key findings revealed the concerning reality that 70% of multiple myeloma patients faced an infection risk during the study, compared to only 32% of the control group. The most common infections noted among these patients were sepsis (20%) and pneumonia (18%), highlighting a significant disparity when compared to controls, who had merely a 4% risk of both infections.

Infection Risk Before Diagnosis

Moreover, patients diagnosed with multiple myeloma were found to have an increased infection risk even prior to diagnosis, with a notable rise in incidence three months before diagnosis. The study reported a hazard ratio (HR) of 1.21 within that time frame, and a risk HR of 1.16 extending four years back.

Specific Infection Risks

The shocking reality is that the clinically significant infection risk for patients with symptomatic multiple myeloma was reported as five times higher than that of healthy individuals. Specifically, bacterial infections were noted to be four to five times more common among these cancer patients compared to controls, while fungal infections presented a risk nearly seven times greater.

Types of Infections

Multiple myeloma patients are particularly susceptible to a range of infections, including the Epstein Barr virus, meningitis, cellulitis, endocarditis, influenza, and various strains of respiratory viruses. Additionally, as age increases, so does the risk of infection, creating a higher vulnerability for older patients.

Mortality Rates

Mortality rates within the first three months post-diagnosis painted an alarming picture: 8% of the multiple myeloma cohort succumbed to infection-related complications, contrasted with just 1% in the control group. By analyzing data from the broader cohort, 32% of the patients with MM experienced infection-related deaths within the first year, compared to 19% of controls.

Conclusion

Furthermore, within 90 days of significant infections, mortality rates soared to 75% after six months and 56% after one year for multiple myeloma patients. These statistics serve as a stark reminder of the deadly potential infections hold for those battling this complex disease.

In conclusion, the authors emphasized the urgent need for preventative measures to mitigate this escalating risk of infections among multiple myeloma patients. As newer therapies such as CAR T-cell therapy emerge, understanding these risks from the pre-immunotherapy era is crucial for developing more effective strategies to safeguard patient health in the ongoing battle against multiple myeloma.