Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group
This document presents a consensus statement from the International Myeloma Working Group (IMWG) on infection prevention in patients with multiple myeloma. It highlights the significant impact of infection on morbidity and mortality in this patient population and emphasizes the need for preventive strategies. The document discusses the risk factors for infection in multiple myeloma, including disease-related factors and treatment-related immunosuppression. It provides recommendations for vaccination, antimicrobial prophylaxis, infection control measures, and immunoglobulin replacement. The importance of individualized treatment plans, timing of immunization, and diagnostic tests for infection is emphasized. The document also addresses the role of healthcare providers and close contacts in preventing infections in multiple myeloma patients.
List of Important Points:
- Infection is the leading cause of morbidity and mortality in patients with multiple myeloma.
- Risk factors for infection in multiple myeloma include disease-related factors (immunoparesis, renal failure, comorbidities) and treatment-related immunosuppression.
- The periods of highest infectious risk are during the first 3 months after diagnosis and when treating relapsed or refractory multiple myeloma.
- Most infections in multiple myeloma are caused by viruses and bacteria, with bacterial infections manifesting as pneumonia and bacteremia, and viral infections presenting as seasonal viruses like influenza and herpes zoster.
- Antibacterial prophylaxis with levofloxacin may be considered during periods of increased infectious risk.
- Acyclovir prophylaxis is recommended for patients seropositive for herpes simplex virus and varicella zoster virus, as well as those receiving certain targeted monoclonal antibodies.
- Trimethoprim-sulfamethoxazole or dapsone may be considered for patients at risk of Pneumocystis jirovecii pneumonia.
- Inactivated influenza vaccine and pneumococcal vaccines are recommended for immunization in multiple myeloma patients.
- The timing of vaccination and the patient's state of immunosuppression affect the development of a protective response.
- Lenalidomide improves response to vaccination, but concurrent use of dexamethasone should be avoided.
- Revaccination is recommended 6-24 months after autologous stem-cell transplantation.
- Recombinant zoster vaccine is recommended after autologous stem-cell transplantation.
- Close contacts of multiple myeloma patients should receive routine vaccinations with inactivated vaccines.
- Healthcare providers caring for multiple myeloma patients should receive all indicated immunizations.
- Intravenous immunoglobulin is reserved for specific situations.
- Travel vaccines and antimicrobial prophylaxis are recommended for multiple myeloma patients traveling to endemic areas.
- Individualized treatment plans, timing of immunization, and diagnostic tests for infection are crucial in reducing the burden of infectious complications in multiple myeloma patients.
- Healthcare providers should follow guidelines from the Centers for Disease Control and Prevention, The Infectious Disease Society of America, and the National Comprehensive Cancer Network for infection prevention in multiple myeloma patients.
- Patients with multiple myeloma should consult with infectious disease specialists or travel clinics when traveling to endemic areas.
- Close contacts of multiple myeloma patients should avoid close contact with recipients of live vaccines when possible.
- Healthcare providers caring for multiple myeloma patients should receive all indicated immunizations, particularly for seasonal influenza viruses.
- Intravenous immunoglobulin may be used in specific situations, such as life-threatening infections and recurrent infections with low IgG concentration.
- The document does not include guidelines for infection prevention in the context of allogeneic hematopoietic stem-cell transplantation or the effect of SARS-CoV-2 in multiple myeloma patients.
Authors:
Noopur S Raje, MD, Elias Anaissie, MD, Shaji K Kumar, MD, Sagar Lonial, MD, Thomas Martin, MD, Morie A Gertz, MD, Amrita Krishnan, MD, Parameswaran Hari, MD, Heinz Ludwig, MD, Elizabeth O'Donnell, MD, Andrew Yee, MD, Jonathan L Kaufman, MD, Adam D Cohen, MD, Laurent Garderet, MD, Ashutosh F Wechalekar, MD, Prof Evangelos Terpos, MD, Navin Khatry, MD, Ruben Niesvizky, MD, Qing Yi, MD, Douglas E Joshua, MD, Tapan Saikia, MD, Nelson Leung, MD, Monika Engelhardt, MD, Mohamad Mothy, MD, Andrew Branagan, MD, Ajai Chari, MD, Anthony J Reiman, MD, Brea Lipe, MD, Joshua Richter, MD, S Vincent Rajkumar, MD, Jesús San Miguel, MD, Kenneth C Anderson, MD, Edward A Stadtmauer, MD, Rao H Prabhala, PhD, Phillip L McCarthy, MD, Nikhil C Munshi, MD
Citation:
Lancet Haematol. 2022 Feb;9(2):e143-e161.
https://doi.org/10.1016/S2352-3026(21)00283-0