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Abstract

Abstract: P647

Type: Poster Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:30 - 19:00

Location: Poster area (Hall 7)

Background

The outcome of patients with multiple myeloma (MM) has improved dramatically in the past years, mainly due to a better control of the disease. However, it is not clear what influence this has on treatment- or disease-related complications like infections. Recent data even suggested an increased rate of infections in patients with MM, possibly associated with the use of novel drugs.

Aims

To determine the rate and the type of infections in MM patients undergoing treatment and to evaluate possible disease- or treatment-related risk-factors.

Methods

All patients with MM treated at our institution between 2003 and 2014 were included in this retrospective analysis after approval by the institutional review board. Data on age, sex, diagnosis, comorbidities, treatment modalities, and infectious complications were recorded. Each type of therapy (e.g. high-dose therapy versus conventional therapy) defined a patient-case (duration per patient-case: beginning of therapy until the beginning of another type of therapy) and infections were recorded per case. To determine risk-factors, generalized estimating equations comparing cases were used.

Results

Four-hundred seventy-nine patients (male: 272, 57%) accounted for 1690 cases (median number of cases per patient 3, range 1-15). At presentation in our institution, median age was 62 (35-89) years, and most patients had advanced disease (Stage III according to Salmon-Durie classification in 364 patients, 76%) and an IgG-paraprotein (255 patients, 53%). Type of therapy given were as follows: 534 (32%) conventional long-term chemotherapy, 514 (30%) induction-type chemotherapy, 237 (14%) chemotherapy for stem-cell mobilisation, 310 (18%) high-dose melphalan with stem-cell transplantation and 95 (6%) supportive care only. One-hundred sixty-six patients (35%) with 295 patient cases never experienced an infection including 25 cases with high-dose melphalan. However, the majority of patients experienced at least one episode of infection throughout their treatment, accounting for 773 infections in 627 patient cases (37% of all patient cases). Most (559, 72%) infections were of bacterial origin including 156 cases with pneumonia (9% of all patient cases). Herpes zoster was noted in 37 patient cases. Relapse (OR 1.9, 95% CI 1.5-2.5, p<0.001) and high-dose chemotherapy (OR 11.3, 95% CI 8.4-15.3, p<0.001) were associated with a higher risk of infection whereas time of treatment (2003-2008 versus 2009-2014) or use of novel drugs did not influence the rate of infection.

Conclusion
More than 60% of MM patients experience at least one episode of infection during their course of treatment. These infections are mostly of bacterial origin and strongly associated with high-dose chemotherapy or relapse. Novel drugs do not seem to influence the rate of infection. Unfortunately, despite the general improvement in the care of patients with MM, no difference in the rate of infections could be detected in recent years.

Session topic: 29. Infectious diseases, supportive care

Keyword(s): Multiple Myeloma, Immunomodulatory thalidomide analog, Proteasome inhibitor

Abstract: P647

Type: Poster Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:30 - 19:00

Location: Poster area (Hall 7)

Background

The outcome of patients with multiple myeloma (MM) has improved dramatically in the past years, mainly due to a better control of the disease. However, it is not clear what influence this has on treatment- or disease-related complications like infections. Recent data even suggested an increased rate of infections in patients with MM, possibly associated with the use of novel drugs.

Aims

To determine the rate and the type of infections in MM patients undergoing treatment and to evaluate possible disease- or treatment-related risk-factors.

Methods

All patients with MM treated at our institution between 2003 and 2014 were included in this retrospective analysis after approval by the institutional review board. Data on age, sex, diagnosis, comorbidities, treatment modalities, and infectious complications were recorded. Each type of therapy (e.g. high-dose therapy versus conventional therapy) defined a patient-case (duration per patient-case: beginning of therapy until the beginning of another type of therapy) and infections were recorded per case. To determine risk-factors, generalized estimating equations comparing cases were used.

Results

Four-hundred seventy-nine patients (male: 272, 57%) accounted for 1690 cases (median number of cases per patient 3, range 1-15). At presentation in our institution, median age was 62 (35-89) years, and most patients had advanced disease (Stage III according to Salmon-Durie classification in 364 patients, 76%) and an IgG-paraprotein (255 patients, 53%). Type of therapy given were as follows: 534 (32%) conventional long-term chemotherapy, 514 (30%) induction-type chemotherapy, 237 (14%) chemotherapy for stem-cell mobilisation, 310 (18%) high-dose melphalan with stem-cell transplantation and 95 (6%) supportive care only. One-hundred sixty-six patients (35%) with 295 patient cases never experienced an infection including 25 cases with high-dose melphalan. However, the majority of patients experienced at least one episode of infection throughout their treatment, accounting for 773 infections in 627 patient cases (37% of all patient cases). Most (559, 72%) infections were of bacterial origin including 156 cases with pneumonia (9% of all patient cases). Herpes zoster was noted in 37 patient cases. Relapse (OR 1.9, 95% CI 1.5-2.5, p<0.001) and high-dose chemotherapy (OR 11.3, 95% CI 8.4-15.3, p<0.001) were associated with a higher risk of infection whereas time of treatment (2003-2008 versus 2009-2014) or use of novel drugs did not influence the rate of infection.

Conclusion
More than 60% of MM patients experience at least one episode of infection during their course of treatment. These infections are mostly of bacterial origin and strongly associated with high-dose chemotherapy or relapse. Novel drugs do not seem to influence the rate of infection. Unfortunately, despite the general improvement in the care of patients with MM, no difference in the rate of infections could be detected in recent years.

Session topic: 29. Infectious diseases, supportive care

Keyword(s): Multiple Myeloma, Immunomodulatory thalidomide analog, Proteasome inhibitor

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