MM Staging, Severe Anemia Linked With High Infection and Mortality Risk

October 7, 2020
Jared Kaltwasser

Newly diagnosed patients with multiple myeloma (MM) face a high risk of infection. A new study helps elucidate key risk factors.

New data is helping to paint a clearer portrait of infection risk among newly diagnosed patients with multiple myeloma (MM).

Writing in the journal BMC Infectious Diseases, investigators, including corresponding author Changxin Shen, MD, PhD, of Zhongnan Hospital of Wuhan University, examined more than 5 years of infection data relating to 161 newly diagnosed patients.

“The increased susceptibility to infection is complicated and multifactorial,” they wrote. “However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission.”

The investigators said they hoped to change that, noting that as many as half of patients with MM who die within 6 months of diagnosis die as a result of infection.

For their study, Shen and colleagues looked at the electronic medical records of patients diagnosed between May of 2013 and December 2018. Patient information was collected at admission, and none of the patients had previously received antineoplastic therapy.

The authors found infections in 126 patients (78.3%) of the 161 patients. The majority (95 patients) had their infections clinically defined, and the remaining 31 patients were diagnosed with infection microbiologically.

Viruses were the primary culprit, which the authors said was a surprise. Forty-four percent of patients with infections had viruses. Bacteria were the cause of infections in 36.6% of patients. Fungus accounted for 19.5% of the total infections. Most infections (64.7%) were respiratory infections.

Among viral infections, Epstein-Barr virus (24.4%) and hepatitis B virus (17.1%) were the most common types of infection. Among those with bacterial infections, gram-negative bacteria were more prevalent than gram-positive bacteria, accounting for 22% and 14.6% of total infections, respectively.

The authors cited a number of factors as indicative of high risk of infection. Among them were stage III scores on the International Staging System (ISS) for MM, more severe anemia (Hb < 90 g/L; P = .044), and elevated C-reactive protein.

In addition, patients who had risk factors for infection also had poorer prognoses, especially if their risk factors were ISS stage and low hemoglobin level.

The authors noted that the finding that ISS stage correlated with infection risk aligns with previous research.

“We hold the opinion that patients with ISS stage III, mostly morbid patients with high disease activity, have poorer prognoses and are susceptible to serious infection complications,” they said.

However, unlike some earlier research, neutropenia did not appear to be linked with infection risk in the present study. Absolute neutrophil count (ANC) data from before treatment showed 80.1% of the infected patients had normal ANC; neutropenia was present in just 11.9% of patients.

Shen and colleagues noted some limitations to their research. Among them, the patient population was small, and the use of interphase fluorescence in situ hybridization was not common, which the authors said resulted in a lack of information on cytogenetics. That meant the authors could not analyze the data based on revised ISS (r-ISS) scores.

Still, the investigators said their findings strongly underscore the significant risks of infection to patients with newly diagnosed MM.

“Infections represented a major threat to patients with newly diagnosed MM, and the existence of risk factors of infection had a strong impact on the prognosis, especially ISS stage III and lower haemoglobin level,” they concluded.

Reference

Lin C, Shen H, Zhou S, et al. Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics. BMC Infect Dis. 2020;20(1):699. Published 2020 Sep 23. doi:10.1186/s12879-020-05412-w