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Shafat T, De-la-Rosa-Martinez D, Khawaja F, Jiang Y, Spallone A, Batista MV, Ariza-Heredia E, Vilar-Compte D, Ahmed S, Becnel M, Chemaly RF. Outcomes and Risk Factors for Influenza and Respiratory Syncytial Virus Lower Respiratory Tract Infections and Mortality in Patients With Lymphoma or Multiple Myeloma: A 7-Year Retrospective Cohort Study. Open Forum Infect Dis 2025; 12:ofaf127. [PMID: 40177586 PMCID: PMC11961405 DOI: 10.1093/ofid/ofaf127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 03/01/2025] [Indexed: 04/05/2025] Open
Abstract
Background Respiratory viral infection (RVI) is a significant complication in patients with hematologic malignancies. While risk factors of lower respiratory tract infections (LRIs) and mortality have been studied in allogeneic hematopoietic cell transplant recipients, data remain limited for patients with lymphoma and multiple myeloma (MM). We investigated outcomes and risk factors of LRI and mortality secondary to respiratory syncytial virus (RSV) or influenza virus (IFV) infections in these populations. Methods We performed a retrospective study in adults with lymphoma or MM with RSV or IFV RVIs between 2016 and 2022. Primary outcomes were LRI and all-cause 30- and 90-day mortality. Results We analyzed 440 patients with 490 consecutive viral episodes: 297 (61%) with MM and 193 (39%) with lymphoma, 258 (52%) were IFV-related, and 234 (48%) RSV-related (2 coinfections). At presentation, 62% were diagnosed with upper respiratory tract infection (URI) and 38% with LRI. During follow-up, 57% were hospitalized, 8% required intensive care unit transfer, and 20 (4%) died within 30 days. On multivariable analysis, RSV infection (vs IFV), current/former smoking, steroid exposure, lymphopenia (≤200 cells/mL), and high serum creatinine were associated with LRI. MM (vs lymphoma) diagnosis, current/former smoking, lymphopenia, and nosocomial infection were associated with 30-day mortality, whereas LRI (vs URI), current/former smoking, and lymphopenia were associated with 90-day mortality. Conclusions We described a high burden of IFV and RSV infections in patients with lymphoma and MM and found risk factors associated with LRI and mortality. These factors could potentially identify high-risk patients, enabling better and prompt management strategies.
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Affiliation(s)
- Tali Shafat
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
| | - Daniel De-la-Rosa-Martinez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, México City, México
- Programa de Estudios Combinados en Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
| | - Marjorie Vieira Batista
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
- Department of Infectious Diseases, AC Camargo Cancer Center, São Paulo, Brazil
| | - Ella Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, México City, México
| | - Sairah Ahmed
- Departments of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melody Becnel
- Departments of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Respiratory Viruses, Basel, Switzerland
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Ding X, Ding J, Gu H, Zhong C. Long-acting granulocyte colony-stimulating factor in primary prophylaxis of early infection in patients with newly diagnosed multiple myeloma. Support Care Cancer 2022; 30:4049-4054. [PMID: 35064823 PMCID: PMC8942935 DOI: 10.1007/s00520-022-06851-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
Purpose This study sought to compare the efficacy of prophylactic long-acting and standard granulocyte colony-stimulating factor (G-CSF) on febrile neutropenia, early infections, and treatment delay in patients with newly diagnosed multiple myeloma (MM) receiving the therapeutic regimen of bortezomib, lenalidomide, and dexamethasone (VRd). Methods A prospective study with 68 consecutive patients with MM was conducted in three regional hospitals. Participants were randomly treated with the VRd regimen in combination with prophylactic long-acting G-CSF (treatment group) or prophylactic standard G-CSF (control group). The primary endpoints were the incidence rates of febrile neutropenia, early infection, and treatment delays. The secondary endpoint was clinical outcomes. Results Thirty-three patients were assigned to the treatment group, and thirty-five patients were assigned to the control group. The incidence of febrile neutropenia was 6.1% and 17.1% in the treatment and control groups, respectively (p = 0.297). However, the rates of early infection and treatment delay were markedly lower in the treatment group than in the control group (6.1% vs. 25.7% and 9.1% vs. 31.4%; p < 0.05). Notably, all early infections occurred during the first four cycles of VRd therapy, and the most common type of infection was pneumonia. No significant difference in clinical efficacy was found between the two groups. All participants achieved at least partial remission. Conclusions Prophylactic administration of domestic long-acting G-CSF markedly reduced the rates of early infection and treatment delay as compared with standard G-CSF in patients newly diagnosed with MM. Notably, all early infections occurred during the first four cycles of VRd therapy. As such, it seems appropriate to administer long-acting G-CSF with the aim of primary prophylaxis of early infection in the setting of newly diagnosed MM.
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Affiliation(s)
- Xinjing Ding
- Department of Undergraduate, The Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Jianghua Ding
- Department of Hematology & Oncology, The Affiliated Hospital of Jiujiang University, No. 57#, Xunyang East Road, Jiujiang, Jiujiang City, Jiangxi Province, China.
| | - Hong Gu
- Department of Hematology & Oncology, The People Hospital of Ruichang, Ruichang, Jiangxi Province, China
| | - Chuanxiang Zhong
- Department of Hematology & Oncology, The No. 171 Hospital of PLA, Jiujiang, Jiangxi Province, China
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Allegra A, Tonacci A, Musolino C, Pioggia G, Gangemi S. Secondary Immunodeficiency in Hematological Malignancies: Focus on Multiple Myeloma and Chronic Lymphocytic Leukemia. Front Immunol 2021; 12:738915. [PMID: 34759921 PMCID: PMC8573331 DOI: 10.3389/fimmu.2021.738915] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Secondary immunodeficiency is reported in most patients with hematological malignancies such as chronic lymphocytic leukemia and multiple myeloma. The aim of our review was to evaluate the existing literature data on patients with hematological malignancies, with regard to the effect of immunodeficiency on the outcome, the clinical and therapeutic approach, and on the onset of noninfectious complications, including thrombosis, pleural effusion, and orofacial complications. Immunodeficiency in these patients has an intense impact on their risk of infection, in turn increasing morbidity and mortality even years after treatment completion. However, these patients with increased risk of severe infectious diseases could be treated with adequate vaccination coverage, but the vaccines' administration can be associated with a decreased immune response and an augmented risk of adverse reactions. Probably, immunogenicity of the inactivated is analogous to that of healthy subjects at the moment of vaccination, but it undertakes a gradual weakening over time. However, the dispensation of live attenuated viral vaccines is controversial because of the risk of the activation of vaccine viruses. A particular immunization schedule should be employed according to the clinical and immunological condition of each of these patients to guarantee a constant immune response without any risks to the patients' health.
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MESH Headings
- Animals
- Humans
- Immunocompromised Host
- Immunogenicity, Vaccine
- Immunologic Deficiency Syndromes/epidemiology
- Immunologic Deficiency Syndromes/immunology
- Immunologic Deficiency Syndromes/therapy
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Multiple Myeloma/epidemiology
- Multiple Myeloma/immunology
- Multiple Myeloma/therapy
- Opportunistic Infections/epidemiology
- Opportunistic Infections/immunology
- Opportunistic Infections/prevention & control
- Risk Factors
- Vaccination
- Vaccine Efficacy
- Vaccines/administration & dosage
- Vaccines/adverse effects
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Sebastiano Gangemi
- School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Raheem A, Rathish B, Charles D, Wilson A, Warrier A. Pneumococcal Bacteremia and Cryptococcal Meningitis Dual Infection in a Patient With Multiple Myeloma. Cureus 2021; 13:e15089. [PMID: 34155458 PMCID: PMC8210704 DOI: 10.7759/cureus.15089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Infections remain one of the major complications in patients with multiple myeloma, having a significant impact on morbidity and mortality. The increased risk of infection in these patients are a result of various factors contributing to the impairment of immune system caused by the disease and the chemotherapy regimens given during the treatment phases. Here we report a rare case of pneumococcal bacteraemia and cryptococcal meningitis dual infection in a patient with underlying multiple myeloma who had a favourable clinical outcome. This case also serves to highlight the importance of adult vaccinations especially in patients with underlying comorbidities.
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Affiliation(s)
| | | | | | - Arun Wilson
- Infectious Diseases, Aster Medcity, Kochi, IND
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Atalla E, Kalligeros M, Mylona EK, Tsikala-Vafea M, Shehadeh F, Georgakas J, Mylonakis E. Impact of Influenza Infection Among Adult and Pediatric Populations With Hematologic Malignancy and Hematopoietic Stem Cell Transplant: A Systematic Review and Meta-Analysis. Clin Ther 2021; 43:e66-e85. [PMID: 33812700 DOI: 10.1016/j.clinthera.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Influenza is increasingly recognized as a leading cause of morbidity and mortality in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation (HSCT). However, the impact of influenza on this population has not been previously evaluated in a systematic review. This study systematically reviewed and summarized the outcomes of influenza infection as to in-hospital influenza-related mortality, development of lower respiratory tract infection and acute respiratory distress syndrome, need for hospitalization, intensive care unit admission, and mechanical ventilation. METHODS We conducted a systematic search of literature using the PubMed and EMBASE databases for articles published from January 1989 through January 19, 2020, reporting laboratory-confirmed influenza in patients of any age with hematologic malignancies and HSCT. Time from transplantation was not included in the search criteria. The impact of antiviral therapy on influenza outcomes was not assessed due to heterogeneity in antiviral treatment provision across the studies. Patients with influenza-like illness, solid-tumor cancers, or nonmalignant hematologic diseases were excluded from the study. A random-effects meta-analysis was performed to estimate the prevalences and 95% CIs of each outcome of interest. A subgroup analysis was carried out to assess possible sources of heterogeneity and to evaluate the potential impact of age on the influenza infection outcomes. Heterogeneity was assessed using the I2 statistic. FINDINGS Data from 52 studies providing data on 1787 patients were included in this analysis. During seasonal epidemics, influenza-related in-hospital mortality was 16.60% (95% CI, 7.49%-27.7%), with a significantly higher death rate in adults compared to pediatric patients (19.55% [95% CI, 10.59%-29.97%] vs 0.96% [95% CI, 0%-6.77%]; P < 0.001). Complications from influenza, such as lower respiratory tract infection, developed in 35.44% of patients with hematologic malignancies and HSCT recipients, with a statistically significant difference between adults and children (46.14% vs 19.92%; P < 0.001). However, infection resulted in a higher hospital admission rate in pediatric patients compared to adults (61.62% vs 22.48%; P < 0.001). For the 2009 H1N1 pandemic, no statistically significant differences were found between adult and pediatric patients when comparing the rates of influenza-related in-hospital mortality, lower respiratory tract infection, and hospital admission. Similarly, no significant differences were noted in any of the outcomes of interest when comparing H1N1 pandemic with seasonal epidemics. IMPLICATIONS Regardless of influenza season, patients, and especially adults, with underlying hematologic malignancies and HSCT recipients with influenza are at risk for severe outcomes including lower respiratory tract infection and in-hospital mortality.
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Affiliation(s)
- Eleftheria Atalla
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Markos Kalligeros
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Evangelia K Mylona
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Maria Tsikala-Vafea
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Fadi Shehadeh
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joanna Georgakas
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
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Cook G, John Ashcroft A, Pratt G, Popat R, Ramasamy K, Kaiser M, Jenner M, Henshaw S, Hall R, Sive J, Stern S, Streetly M, Bygrave C, Soutar R, Rabin N, Jackson GH, the United Kingdom Myeloma Forum. Real-world assessment of the clinical impact of symptomatic infection with severe acute respiratory syndrome coronavirus (COVID-19 disease) in patients with multiple myeloma receiving systemic anti-cancer therapy. Br J Haematol 2020; 190:e83-e86. [PMID: 32438482 PMCID: PMC7280609 DOI: 10.1111/bjh.16874] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Gordon Cook
- Leeds Institute of Clinical Trial Research & Leeds Cancer CentreUniversity of LeedsLeedsUK
| | - A John Ashcroft
- Department of HaematologyPinderfields Hospital, Mid Yorkshire NHS TrustWakefieldUK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Rakesh Popat
- Department of HaematologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | | | | | - Matthew Jenner
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Sarah Henshaw
- Department of HaematologyNottingham City HospitalNottinghamUK
| | - Rachel Hall
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation TrustBournemouthUK
| | - Jonathan Sive
- Department of HaematologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Simon Stern
- Department of HaematologyEpsom & St Helier University Hospitals NHS TrustCarshaltonUK
| | | | - Ceri Bygrave
- Department of HaematologyUniversity Hospital of WalesCardiffUK
| | | | - Neil Rabin
- Department of HaematologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Graham H Jackson
- Northern Institute for Cancer ResearchNewcastle UniversityNewcastle upon TyneUK
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Li L, Wang L. Multiple Myeloma: What Do We Do About Immunodeficiency? J Cancer 2019; 10:1675-1684. [PMID: 31205523 PMCID: PMC6548011 DOI: 10.7150/jca.29993] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is an incurable hematological malignancy. Immunodeficiency results in the incapability of immunity to eradicate both tumor cells and pathogens. Immunotherapies along with antibiotics and other anti-infectious agents are applied as substitutes for immunity in MM. Immunotherapies including monoclonal antibodies, immune checkpoints inhibitors, affinity- enhanced T cells, chimeric antigen receptor T cells and dendritic cell vaccines are revolutionizing MM treatment. By suppressing the pro-inflammatory milieu and pathogens, prophylactic and therapeutic antibiotics represent anti-tumor and anti-infection properties. It is expected that deeper understanding of infection, immunity and tumor physio-pathologies in MM will accelerate the optimization of combined therapies, thus improving prognosis in MM.
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Affiliation(s)
- Linrong Li
- Second Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Hematology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
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