Managing the Risk of Infection for Patients with Multiple Myeloma

Colleen Moretti: What is the risk patients with multiple myeloma pose when it comes to infection? What kind of infections are they are risk for?

Dr. Joseph Mikhael: I think it's important to remember that one of the things that makes myeloma a little bit unique compared to many other cancers, is that it really is a cancer of a part of the immune system. And so, the immune system inevitably is impaired and that puts people at risk of infections — even before patients are given treatments, which we know sometimes can even further increase people's risk of infection. Just having the disease of myeloma itself, unfortunately, puts people at risk of infection. Myeloma is a cancer of the cells that make antibodies. You know, during the pandemic, we've all been talking about antibodies, and these are the things that protect us from infections. And so, the very cells that make those antibodies are impaired with myeloma. And so, people are at risk of really almost every kind of infection. There are certain infections that are more common, as to your question that we see in myeloma patients. But I think it's important for people to know that any potential infection they're at higher risk of. We know that in particular, we see chest infections or upper respiratory tract infections, more commonly in the myeloma population.

Moretti: How importance are vaccinations in preventing the risk of infection? Can they help reduce the risk?

Mikhael: Yes. Yes. And yes. One of the things that we've learned not just through the pandemic, but well before the pandemic, is that we have to be very strategic in the way we deal with potential infections in myeloma patients. And there are things that the patient can do and there are things that as the healthcare team we can do and the things of course, that we do together — and one of those are vaccinations. And we've learned that not just COVID vaccinations, but the kind of vaccinations that typically we as physicians will discuss with our patients. Getting the Pneumovax (pneumococcal polysaccharide vaccine) becomes particularly important, getting the flu shot becomes important. If patient has a patient has had a stem cell transplant, then it becomes important for us to if you will top up the routine infections for prophylaxis or the vaccinations that we get when we're children. So, vaccinations play a very important role in protecting myeloma patients from infection.

Moretti: Is there anything patients with multiple myeloma can do to reduce their risk of infection, such as diet and exercise?

Mikhael: Absolutely, there are several things that we can do sort of proactively and reactively. So proactively, you've identified that already, there are things that in general can reduce our risk of infections. We know that for example, obesity, unfortunately, is connected to a greater risk of infection. So, if people can modulate their diets and their activities in such a way that that can be prevented, that would be helpful. We do know that generally speaking, exercise is actually very good for us — it keeps the lungs upright, it opens them up. And these kinds of things to reduce the risk of getting what I mentioned earlier are more common in myeloma patients, which is upper respiratory tract infections. But also, reactionary if someone develops a fever, if someone develops a cough or the symptoms that we all know are associated with infections, it's important also to if you will jump on it early enough in discussing this with their health care team so that we can determine is this a serious infection, is one that requires antibiotics — because often our patients are either on treatment or have lower immunity to fight these infections that at the earliest signs of infection, we want to intervene and prevent it from becoming worse.

Moretti: What kind of recourses does the International Myeloma Foundation (IMF) have for patients when it comes to managing the risk of infection?

Mikhael: Well, we're very blessed at the IMF to have created really massive resources to help myeloma patients through their whole journey of myeloma. Even the MGUS and smoldering phases we discussed before, but also in the whole element of their treatment from their first treatment to all the things that happened during their life. And these resources are available to our patients at myeloma.org on the website, but also at our info line as well that they can read about at the website.

And specific to infections, we do have multiple booklets that provide information about the importance of vaccinations, of how we can reduce our risk of infections, of what to be able to speak to your physician about when you have signs and symptoms that can be consistent with an infection. And we're always there to try and provide help and support individuals through the info line and through the website so that patients can understand it better because I think one of the maybe tiny silver linings of the pandemic was realizing how important that communication is with your health care team so that we can identify risks early and overcome them before they become a real problem.