Infection Prevention in Patients With Multiple Myeloma
By: Celeste L. Dixon
Posted: Thursday, February 8, 2018
Do physicians routinely use primary prophylaxis to reduce the incidence of infection in patients with multiple myeloma? The answer seems to be no, according to a review published in the Annals of Hematology by a European team led by Xavier Leleu, MD, PhD, of the Department of Hematology, Hôpital La Milétrie Poitiers, France. As recombinant granulocyte colony-stimulating factor (G-CSF) prophylaxis may be useful in myeloma patients at high risk of prolonged severe neutropenia, further studies on ways to optimize this strategy are warranted.
The authors found that “few papers” of the dozens reviewed, covering numerous multiple myeloma therapies, “report the use of G-CSFs in patients with multiple myeloma receiving anticancer treatments, and fewer describe whether G-CSF was beneficial. None of the identified studies reported G-CSF primary prophylaxis.” G-CSFs were notably absent, despite the fact that organizations such as the European Organisation for the Research and Treatment of Cancer have detailed guidelines for their prophylactic use in multiple myeloma treatment, which vary based on patient profiles and the anticancer agents used.
In other tumor types, the long-acting G-CSF pegfilgrastim may improve outcomes versus the use of daily G-CSFs. So far, Dr. Leleu and colleagues noted, there’s not enough evidence to know whether the same would hold true for patients with multiple myeloma, but the team is nonetheless confident pegfilgrastim may well be of benefit to those at high risk of neutropenia, “including those whose chemotherapy regimen is particularly myelotoxic, who have a high tumor burden, and/or who are elderly or frail.”