People living with multiple myeloma (MM) are seven times more likely to develop an infection compared with the general population. For men with myeloma and older people, the risk may be even higher. Those with myeloma are more vulnerable to infections because their immune systems are suppressed by myeloma itself as well as by myeloma treatments.

Infections are the leading cause of early death in those with MM. You can help protect yourself or your loved one with myeloma by taking preventive measures to lower the risk of infection.

Multiple Myeloma as a Risk Factor for Infection

Myeloma is a blood cancer of the immune system — in particular, the plasma cells found in the bone marrow. Healthy plasma cells make proteins called antibodies or immunoglobulins, which help protect people from infections. In people living with myeloma, plasma cells make abnormal antibodies, known as paraproteins or M proteins, that do not function properly or provide protection. The resulting immunosuppression is a key risk factor for infection vulnerability in people living with MM and related conditions.

The risk for infection rises even before myeloma is diagnosed. It’s higher in people with the related blood cell disorder called monoclonal gammopathy of undetermined significance. It can develop into myeloma in some people, and the risk increases with greater disease activity.

Myeloma Treatments and Infection Risk

Anti-myeloma therapies further suppress the immune system, lowering its ability to fight off foreign invaders. Because of this, many MM treatments are a significant risk factor for infections.

Therapies for myeloma that increase infection vulnerability include:

• Immunomodulatory drugs
• Chemotherapy drugs
• Radiation therapy
• Steroids
• Stem cell transplantation

Immunomodulatory Drugs

Immunomodulatory drugs, including lenalidomide (Revlimid) and pomalidomide (Pomalyst), have been found to increase the risk of infections in those with multiple myeloma. One report showed that 42 percent of people treated with the drug thalidomide (Thalomid) developed infections, 19 percent of which were severe.

Chemotherapy Drugs

Chemotherapy drugs can decrease the number of white blood cells in the body, increasing the risk of infections. Such drugs include proteasome inhibitors — carfilzomib (Kyprolis), bortezomib (Velcade), and ixazomib (Ninlaro) and alkylating agents — cyclophosphamide (Cytoxan), melphalan (Alkeran), and bendamustine (Treanda).

Radiation Therapy

As with chemotherapy, radiation therapy (also called radiotherapy) can increase a person’s risk of developing infections due to a low white blood cell count. One type of radiotherapy, known as total body irradiation, is particularly likely to drastically decrease white blood cell counts.

Steroids

Dexamethasone is a type of corticosteroid (or steroid) medication frequently used in myeloma treatment. These medications suppress the immune system, making a person more susceptible to infections. Steroid drugs can also trigger viruses lingering after past infections or worsen an existing infection.

Stem Cell Transplantation

High-dose chemotherapy is given before a stem cell transplantation to destroy the bone marrow and immune system. Stem cell transplantations can also damage the skin and mucous membranes, making it easier for a virus or bacteria to enter the body and cause infection.

Other Procedures

Some myeloma therapies and diagnostic procedures are also associated with complications that further increase the risk of infection around catheters or after bone marrow aspiration or biopsy.

Common Types of Infections in Myeloma

People with myeloma are more vulnerable to certain types of infections, including:

• Respiratory infections
• Staphylococcus infections
• Escherichia coli infections (also known as E. coli)
• Fungal infections such as candida (thrush or vaginal yeast infection)
• Gastrointestinal infections
• Urinary infections
• Viral infections, including reactivation of the virus that causes shingles

One study revealed that people with myeloma are 10 times more likely than the general population to develop viral infections and seven times more likely to develop bacterial infections.

Vaccination To Reduce Infection Risks

Vaccination is one of the most successful medical interventions against infections. Depending on your myeloma treatment and immune function, you may have a less effective response to vaccination, so a doctor may need to schedule a vaccine around treatment, monitor your response, or repeat a vaccination if necessary.

Vaccinations recommended for people with myeloma (and often their caregivers and family members) include:

• Influenza (flu) vaccine by injection, not nasal mist
• COVID-19
• Shingles (herpes zoster) for varicella-zoster virus
• Measles, mumps, and rubella for some people
• Pneumonia vaccine for those who have an increased susceptibility to pneumococcal infection
• Haemophilus influenzae to help prevent pneumonia, meningitis, and sepsis
• Tetravalent capsular polysaccharide conjugate vaccine to help prevent meningococcal disease

Talk to your oncology specialist about which vaccines you should receive and whether it is important to time them with myeloma treatment.

Other Ways To Lower Infection Risk With Myeloma

In addition to vaccines, there are other treatments and preventive measures for managing infection risk with myeloma:

• Intravenous immunoglobulin treatments
• Practice good hygiene
• Avoid public spaces
• Stay hydrated
• Practice safe sex

Intravenous Immunoglobulin Treatments

For people with MM who have low antibody levels, intravenous immunoglobulin, made up of donor antibodies, can be administered regularly to increase these antibodies and help prevent infections.

Practice Good Hygiene

The Centers for Disease Control and Prevention recommends frequent hand-washing with soap and warm water to lower the risk of infections.

It is important to wash your hands thoroughly:

• After using the bathroom, coughing, sneezing, or blowing your nose
• Before eating or preparing food
• Before touching your face
• After touching animals or handling garbage/waste
• After being in public spaces
• After taking off gloves used to handle anything with germs

If you can’t wash your hands while you are out, you should use an alcohol-based sanitizer. Use wipes before touching objects or surfaces that have been touched by others, such as keypads and door handles.

Other hygiene tips recommended by the American Cancer Society to help prevent infections include:

• Wear shoes at all times to avoid introducing germs and injuries to your feet.
• Bathe or shower every day.
• Brush with a soft toothbrush.
• Use an electric shaver to prevent nicks, and don’t share shaving supplies.
• Avoid vaginal suppositories and tampons.
• Don’t clean animal litter boxes or cages.
• Don’t keep living plants or fresh flowers where you sleep.
• Use hot water when doing dishes.
• Never share towels or drinking glasses.
• Avoid places where dust can be blown into the air.

Avoid Public Spaces

When you’re immunocompromised, it’s best to avoid large gatherings and crowds when possible. If you can’t, wear a mask and stay away from anyone with an infection, fever, or flu. It is also best to also avoid salons, spas, and public bodies of water, like lakes, hot tubs, or public swimming pools.

Hydration

Constipation can cause bladder infections. It is important to prevent constipation by hydrating, exercising, and eating a healthy diet. Your oncologist can tell you which exercises are safe and how much water to drink daily. They may also recommend or prescribe a stool softener for chronic constipation.

Practice Safe Sex

Avoid sexually transmitted infections by using latex or plastic condoms. Although hormonal contraceptives (birth control) can prevent pregnancy, they cannot protect you from sexually transmitted infections.

Signs of Infection

Be alert for signs and symptoms of infection and talk to your doctor if you notice the following:

• Fever
• New areas of tenderness, redness, or swelling
• Pain or burning during urination
• Yellowish discharge or pus
• White patches or sores in the mouth
• Shortness of breath or a new cough
• New abdominal pain
• Chills followed by sweating
• Sore throat

If you can’t drink fluids or if you develop a fever with shaking and chills, talk to your health care team right away.

Find Your Team

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. More than 15,000 members from around the globe come together to ask questions, offer support and guidance, and connect with others who understand life with MM.

Have you experienced infections while living with myeloma? Share your story in the comments below or by posting on MyMyelomaTeam.