INFECTIONS IN MULTIPLE MYELOMA: AN UNDERSTIMATE RISK FACTOR OF COMORBIDITY
(Abstract release date: 05/19/16)
EHA Library. Barilà G. 06/09/16; 134871; PB1971
Dr. Gregorio Barilà
Contributions
Contributions
Abstract
Abstract: PB1971
Type: Publication Only
Background
Multiple myeloma (MM) represents the second most common haematological malignancy characterized by the proliferation of monoclonal plasma cells in the bone marrow. The natural history of the disease may be complicated by the occurrence of infections that can be related to the development of neutropenia (mostly therapy related) and/or hypogammaglobulinemia. Immunoglobulin (Ig) classes defect represents a major characteristic of this disease both in the indolent phase (smouldering MM, sMM), where immunoparesis constitute a risk factor for progression to active Myeloma according to the Spanish Group risk model, and in symptomatic Myeloma. Furthermore, this deficit can be worsen by concomitant chemotherapy.
Aims
The aim of this study was to analyse the frequency, the type and the major risks factors of severe infections in our cohort of patients affected by MM.
Methods
A cohort of 291 patients affected by MM (93 smouldering MM, 198 symptomatic MM) followed from 1996 to 2015 was retrospectively studied for the presence of severe infections (infections requiring hospitalization) during the natural history of the disease. Infections were distinguished in neutropenia related infections and not neutropenia related infections according to Absolute Neutrophil Count (ANC <1,000/μl or ANC>1,000/μl respectively). Durie-Salmon (DS) and ISS staging system were used for MM patients staging.
Results
Seventy-three out of 291 patients developed severe infections during the natural history of the disease (98 total events). The majority of these infections occurred in symptomatic MM patients (70 out of 73 patients with 93 out of 98 infections); as a consequence, infections were significantly associated to symptomatic MM (p<0.001, χ2=34.76). Among symptomatic patients, 40 patients (45 infections) developed infectious events at the time of the diagnosis and/or during induction therapy, while the other 30 patients (48 infectious events) received at least one prior therapy before the event. Interestingly, 26 events (28%) occurred in neutropenic patients while remnant 67 (72%) in not neutropenic patients. Furthermore, almost all neutropenia related infections were also therapy related (25/26, 96%), while almost 30% of neutropenia unrelated infections (20 out of 67) occurred in patients out of therapy. In particular, infections represented Myeloma defining event in 11 patients (12% of total infections, 16% of neutropenia unrelated infections). Thirty-nine of remnant 47 infectious events (83%) occurred in patients treated with novel agents with predominance of proteasome inhibitors based therapy with respect to IMIDs based therapy (26 vs 11), with 2 events occurring during combination therapy. DS stage III and ISS III were significant associated to severe infections (DS p<0,05, χ2=5,5; ISS p<0,05, χ2=6,33); furthermore, DS stage III and ISS stage III were statistically related to neutropenia unrelated infections (p<0,05, χ2=6,3), while there was no significant relationship to neutropenia related infections.
Conclusion
Severe infections represent a significant comorbidity in MM, in particular in symptomatic MM, while sMM patients are generally saved. Most of these type of infections involve not neutropenic patients characterized by high risk disease and developed during induction therapy. These results allow to stratify and to identify those patients who may eventually benefit from immunoglobulin supplementation.
Session topic: E-poster
Keyword(s): Infection, Multiple myeloma, Neutropenia, Staging
Type: Publication Only
Background
Multiple myeloma (MM) represents the second most common haematological malignancy characterized by the proliferation of monoclonal plasma cells in the bone marrow. The natural history of the disease may be complicated by the occurrence of infections that can be related to the development of neutropenia (mostly therapy related) and/or hypogammaglobulinemia. Immunoglobulin (Ig) classes defect represents a major characteristic of this disease both in the indolent phase (smouldering MM, sMM), where immunoparesis constitute a risk factor for progression to active Myeloma according to the Spanish Group risk model, and in symptomatic Myeloma. Furthermore, this deficit can be worsen by concomitant chemotherapy.
Aims
The aim of this study was to analyse the frequency, the type and the major risks factors of severe infections in our cohort of patients affected by MM.
Methods
A cohort of 291 patients affected by MM (93 smouldering MM, 198 symptomatic MM) followed from 1996 to 2015 was retrospectively studied for the presence of severe infections (infections requiring hospitalization) during the natural history of the disease. Infections were distinguished in neutropenia related infections and not neutropenia related infections according to Absolute Neutrophil Count (ANC <1,000/μl or ANC>1,000/μl respectively). Durie-Salmon (DS) and ISS staging system were used for MM patients staging.
Results
Seventy-three out of 291 patients developed severe infections during the natural history of the disease (98 total events). The majority of these infections occurred in symptomatic MM patients (70 out of 73 patients with 93 out of 98 infections); as a consequence, infections were significantly associated to symptomatic MM (p<0.001, χ2=34.76). Among symptomatic patients, 40 patients (45 infections) developed infectious events at the time of the diagnosis and/or during induction therapy, while the other 30 patients (48 infectious events) received at least one prior therapy before the event. Interestingly, 26 events (28%) occurred in neutropenic patients while remnant 67 (72%) in not neutropenic patients. Furthermore, almost all neutropenia related infections were also therapy related (25/26, 96%), while almost 30% of neutropenia unrelated infections (20 out of 67) occurred in patients out of therapy. In particular, infections represented Myeloma defining event in 11 patients (12% of total infections, 16% of neutropenia unrelated infections). Thirty-nine of remnant 47 infectious events (83%) occurred in patients treated with novel agents with predominance of proteasome inhibitors based therapy with respect to IMIDs based therapy (26 vs 11), with 2 events occurring during combination therapy. DS stage III and ISS III were significant associated to severe infections (DS p<0,05, χ2=5,5; ISS p<0,05, χ2=6,33); furthermore, DS stage III and ISS stage III were statistically related to neutropenia unrelated infections (p<0,05, χ2=6,3), while there was no significant relationship to neutropenia related infections.
Conclusion
Severe infections represent a significant comorbidity in MM, in particular in symptomatic MM, while sMM patients are generally saved. Most of these type of infections involve not neutropenic patients characterized by high risk disease and developed during induction therapy. These results allow to stratify and to identify those patients who may eventually benefit from immunoglobulin supplementation.
Session topic: E-poster
Keyword(s): Infection, Multiple myeloma, Neutropenia, Staging
Abstract: PB1971
Type: Publication Only
Background
Multiple myeloma (MM) represents the second most common haematological malignancy characterized by the proliferation of monoclonal plasma cells in the bone marrow. The natural history of the disease may be complicated by the occurrence of infections that can be related to the development of neutropenia (mostly therapy related) and/or hypogammaglobulinemia. Immunoglobulin (Ig) classes defect represents a major characteristic of this disease both in the indolent phase (smouldering MM, sMM), where immunoparesis constitute a risk factor for progression to active Myeloma according to the Spanish Group risk model, and in symptomatic Myeloma. Furthermore, this deficit can be worsen by concomitant chemotherapy.
Aims
The aim of this study was to analyse the frequency, the type and the major risks factors of severe infections in our cohort of patients affected by MM.
Methods
A cohort of 291 patients affected by MM (93 smouldering MM, 198 symptomatic MM) followed from 1996 to 2015 was retrospectively studied for the presence of severe infections (infections requiring hospitalization) during the natural history of the disease. Infections were distinguished in neutropenia related infections and not neutropenia related infections according to Absolute Neutrophil Count (ANC <1,000/μl or ANC>1,000/μl respectively). Durie-Salmon (DS) and ISS staging system were used for MM patients staging.
Results
Seventy-three out of 291 patients developed severe infections during the natural history of the disease (98 total events). The majority of these infections occurred in symptomatic MM patients (70 out of 73 patients with 93 out of 98 infections); as a consequence, infections were significantly associated to symptomatic MM (p<0.001, χ2=34.76). Among symptomatic patients, 40 patients (45 infections) developed infectious events at the time of the diagnosis and/or during induction therapy, while the other 30 patients (48 infectious events) received at least one prior therapy before the event. Interestingly, 26 events (28%) occurred in neutropenic patients while remnant 67 (72%) in not neutropenic patients. Furthermore, almost all neutropenia related infections were also therapy related (25/26, 96%), while almost 30% of neutropenia unrelated infections (20 out of 67) occurred in patients out of therapy. In particular, infections represented Myeloma defining event in 11 patients (12% of total infections, 16% of neutropenia unrelated infections). Thirty-nine of remnant 47 infectious events (83%) occurred in patients treated with novel agents with predominance of proteasome inhibitors based therapy with respect to IMIDs based therapy (26 vs 11), with 2 events occurring during combination therapy. DS stage III and ISS III were significant associated to severe infections (DS p<0,05, χ2=5,5; ISS p<0,05, χ2=6,33); furthermore, DS stage III and ISS stage III were statistically related to neutropenia unrelated infections (p<0,05, χ2=6,3), while there was no significant relationship to neutropenia related infections.
Conclusion
Severe infections represent a significant comorbidity in MM, in particular in symptomatic MM, while sMM patients are generally saved. Most of these type of infections involve not neutropenic patients characterized by high risk disease and developed during induction therapy. These results allow to stratify and to identify those patients who may eventually benefit from immunoglobulin supplementation.
Session topic: E-poster
Keyword(s): Infection, Multiple myeloma, Neutropenia, Staging
Type: Publication Only
Background
Multiple myeloma (MM) represents the second most common haematological malignancy characterized by the proliferation of monoclonal plasma cells in the bone marrow. The natural history of the disease may be complicated by the occurrence of infections that can be related to the development of neutropenia (mostly therapy related) and/or hypogammaglobulinemia. Immunoglobulin (Ig) classes defect represents a major characteristic of this disease both in the indolent phase (smouldering MM, sMM), where immunoparesis constitute a risk factor for progression to active Myeloma according to the Spanish Group risk model, and in symptomatic Myeloma. Furthermore, this deficit can be worsen by concomitant chemotherapy.
Aims
The aim of this study was to analyse the frequency, the type and the major risks factors of severe infections in our cohort of patients affected by MM.
Methods
A cohort of 291 patients affected by MM (93 smouldering MM, 198 symptomatic MM) followed from 1996 to 2015 was retrospectively studied for the presence of severe infections (infections requiring hospitalization) during the natural history of the disease. Infections were distinguished in neutropenia related infections and not neutropenia related infections according to Absolute Neutrophil Count (ANC <1,000/μl or ANC>1,000/μl respectively). Durie-Salmon (DS) and ISS staging system were used for MM patients staging.
Results
Seventy-three out of 291 patients developed severe infections during the natural history of the disease (98 total events). The majority of these infections occurred in symptomatic MM patients (70 out of 73 patients with 93 out of 98 infections); as a consequence, infections were significantly associated to symptomatic MM (p<0.001, χ2=34.76). Among symptomatic patients, 40 patients (45 infections) developed infectious events at the time of the diagnosis and/or during induction therapy, while the other 30 patients (48 infectious events) received at least one prior therapy before the event. Interestingly, 26 events (28%) occurred in neutropenic patients while remnant 67 (72%) in not neutropenic patients. Furthermore, almost all neutropenia related infections were also therapy related (25/26, 96%), while almost 30% of neutropenia unrelated infections (20 out of 67) occurred in patients out of therapy. In particular, infections represented Myeloma defining event in 11 patients (12% of total infections, 16% of neutropenia unrelated infections). Thirty-nine of remnant 47 infectious events (83%) occurred in patients treated with novel agents with predominance of proteasome inhibitors based therapy with respect to IMIDs based therapy (26 vs 11), with 2 events occurring during combination therapy. DS stage III and ISS III were significant associated to severe infections (DS p<0,05, χ2=5,5; ISS p<0,05, χ2=6,33); furthermore, DS stage III and ISS stage III were statistically related to neutropenia unrelated infections (p<0,05, χ2=6,3), while there was no significant relationship to neutropenia related infections.
Conclusion
Severe infections represent a significant comorbidity in MM, in particular in symptomatic MM, while sMM patients are generally saved. Most of these type of infections involve not neutropenic patients characterized by high risk disease and developed during induction therapy. These results allow to stratify and to identify those patients who may eventually benefit from immunoglobulin supplementation.
Session topic: E-poster
Keyword(s): Infection, Multiple myeloma, Neutropenia, Staging
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