Myeloma and Infection!?

What’s the deal with myeloma and infection??? Almost half of all myeloma patients die, not from their myeloma, but from infection?

The video linked below will explain this issue better than I can. Both MM the disease as well as FDA approved “safe and effective” therapies cause MM immune systems to weaken.

Why are myeloma patients more prone to infection?

Why do almost half of all myeloma patients die from infection?

1. Impaired Immune Function

Immunoglobulin Deficiency: Myeloma is a cancer of plasma cells, which are responsible for producing antibodies. In myeloma, abnormal plasma cells dominate the bone marrow, leading to decreased production of normal, functional antibodies. This condition, known as hypogammaglobulinemia, leaves patients vulnerable to infections.
Immune Suppression: Myeloma disrupts the balance of immune cells, including T-cells and natural killer cells, impairing the immune system’s ability to respond to infections.

2. Bone Marrow Suppression

The cancerous plasma cells crowd out normal blood-forming cells in the bone marrow, leading to reduced production of white blood cells (neutropenia). Neutropenia compromises the body’s first line of defense against bacterial and fungal infections.

3. Treatments that Suppress Immunity

Chemotherapy and Steroids: Common treatments for myeloma, such as chemotherapy and corticosteroids, suppress the immune system further by damaging white blood cells and weakening the immune response.
Stem Cell Transplants: For patients undergoing autologous or allogeneic stem cell transplants, the immune system is profoundly weakened during the recovery period, significantly increasing infection risk.

4. Frequent Hospitalizations and Procedures

Myeloma patients often require frequent hospital visits for treatments like infusions, dialysis (if kidneys are affected), or surgeries, exposing them to healthcare-associated infections (e.g., pneumonia, bloodstream infections).

5. Disease-Related Organ Damage

Kidney Damage: Myeloma frequently causes renal dysfunction, which impairs the body’s ability to clear infections.
Bone Lesions: Skeletal damage and fractures caused by myeloma can limit mobility, making patients more susceptible to complications like respiratory infections.

6. Common Infections in Myeloma

Bacterial infections such as pneumonia, bloodstream infections (sepsis), and urinary tract infections are particularly common.
Viral infections (e.g., shingles from reactivation of the varicella-zoster virus) and fungal infections can also occur.

7. Delayed Diagnosis of Infections

Symptoms of infection may overlap with symptoms of myeloma or side effects of treatment, leading to delayed recognition and treatment of infections.

Mitigation Strategies

Efforts to reduce infection-related mortality in myeloma patients include:

Prophylactic Antibiotics/Antivirals: Administering preventive medications to high-risk patients.
Immunoglobulin Replacement Therapy: Providing intravenous immunoglobulins (IVIG) to support the immune system.
Vaccinations: Ensuring up-to-date vaccinations, including for influenza, pneumococcus, and COVID-19.
Infection Surveillance and Early Treatment: Close monitoring for signs of infection and prompt treatment.

Could evidence-based non-conventional immune boosting therapies such as:

Probiotics
Acupuncture
Polyphenols

help myeloma patients manage their immune systems while undergoing chemotherapy to help their immune system fight infections? I am only a long-term MM survivor not a medical professional. That makes too much sense to me…

Email me at David.PeopleBeatingCancer@gmail.com with questions about MM and your immune system.

Hang in there.

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Treatment and Disease-Related Complications in Multiple Myeloma: Implications for Survivorship

“Survivorship care model in cancers requiring a fixed-duration therapy may not be applicable to myeloma, since patients are exposed to multiple lines of continuous therapy along the disease trajectory.

The two most common therapy-related causes of death, which require special consideration, are infection and second cancers.

Identifying patients at a high risk of toxicities will facilitate individualized treatment selection and designing clinical trials for protective strategies targeting those patients.

For example, prophylactic antibiotic or immunoglobulin replacement can be tested for primary prevention of infections in high-risk patients.

Long-term follow up of ongoing trials and epidemiologic data will help identify the nature and trajectory of rare toxicities with a long latency, such as secondary cancers.

Patients who are frail, have persistent renal insufficiency, and refractory to multiple lines of therapy need special attention regarding treatment toxicity and quality of life.

In this review, we discuss the incidence, risk-factors, and management of treatment and disease-related complications in myeloma, discuss knowledge gaps and research priorities in this area, and propose a survivorship care model to improve health-care delivery to a growing pool of myeloma survivors…”

Second Primary Malignancies After Auto-HSCT Linked to Inferior Outcomes in MM

“The researchers analyzed data from 3948 adults with MM who had a first auto-HSCT with melphalan conditioning between 2011 and 2018 and then received post-HSCT maintenance. The median age at transplant was 61 (range, 20-82) years…

Lenalidomide (alone or in combination) was the most commonly reported maintenance regimen (n=2836). The median follow-up was 37 months…

SPMs occurred in 4% of patients (n=175) overall, with solid tumors comprising 64% of new SPMs.

Melanoma (19%) and
genitourinary malignancies (18%) were the most commonly observed SPMs.

The median time from auto-HSCT to SPM development was 33 months.

Among the 63 patients who developed SHMs,

57% had myeloid malignancies,
5% had lymphoid malignancies, and
38% had SHMs not otherwise specified.

The median time from auto-HSCT to SHM development was 35 months…

At 3 years, the cumulative incidence of SPMs was 3.3%,
the incidence of SHMs was 1.1%, and
the incidence of therapy-related myeloid neoplasms was 0.7%.

Among the 404 patients who had a history of prior malignancy at baseline, 31 developed another malignancy after auto-HSCT. The incidence of SPMs did not differ significantly according to maintenance regimen.

At last follow-up, 16% of patients who did not develop an SPM had died, and MM was the most common cause of death (85%). The death rate was 38% among patients who developed an SPM and 54% among patients who developed an SHM. In both groups, MM was still the most common cause of death (42% and 53%, respectively), followed by SPM (30%) and SHM (18%)…

“[T]he development of SPM and SHM leads to a poor survival in MM patients and is an important survivorship challenge,” the researchers wrote. “Given the median survival for MM continues to improve, continued vigilance is needed to assess the risks of SPM and SHM with maintenance therapy post-auto-HSCT.””

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