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Risk Factors for Bloodstream Infections and Early Mortality in Multiple Myeloma

By: Vanessa A. Carter, BS
Posted: Thursday, May 6, 2021

Tomas Garcia De Haro Muñoz, PhD, of Hospital Universitario San Cecilio, Granada, Spain, and colleagues carried out a study to determine whether heavy + light chain (HLC) pair suppression is a risk factor for early death and bloodstream infections in patients with multiple myeloma. These researchers discovered this association holds significance, and patients older than 65 with extreme HLC pair suppression had the highest risk of early death. Their findings were published in Frontiers in Oncology.

The investigators focused on 115 patients with multiple myeloma who were newly diagnosed and had intact immunoglobulin. Using patient medical records, the investigators collected clinical data such as age, sex, myeloma subtype and stage, and presence of immunoglobulin HLC pairs. Patient data were also analyzed for bloodstream infections and early mortality within 6 months of diagnosis.

The median patient age was 68, with a majority older than 65. An abnormal HLC ratio was observed in all patients at diagnosis. Stage I, II, and III disease was discovered in 22%, 22%, and 56% of individuals, respectively.

Bloodstream infections occurred in 24 patients, with Streptococcus pneumoniae (n = 8) presenting most frequently. This group demonstrated highly abnormal HLC ratios (P = .02), a high frequency of pair suppression (P = .001), and a significant percentage of cytogenetic alterations (P = .019). Severe and extreme HLC pair suppression was significantly more associated with infections within 6 months of diagnosis than those without such suppression. 

The median follow-up was 15 months, and 21 patients died within 6 months of diagnosis. The primary cause of death was an infection, which accounted for 14 cases. Age (hazard ratio [HR] = 3.71), extreme HLC pair suppression (HR = 5.14), and bloodstream infections (HR = 5.12) were independent predictors for early mortality. Additionally, overall survival was significantly shorter for those with bloodstream infections and HLC pair suppression than those without it.

Disclosure: The study authors reported no conflicts of interest.

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