A post-hoc analysis presented at the European Hematology Association (EHA) Annual Meeting (June 11-21, 2020) led to a new risk prediction score for early severe infection in patients with multiple myeloma.
Many patients with multiple myeloma are prone to severe infection – particularly in the 4 months post-diagnosis. A common belief is that prophylactic antibiotic treatment may decrease the frequency and severity of early infections, but limited data exist to support this belief. Score systems to predict risk of infection are needed to help identify patient populations that will benefit from prophylactic antibiotics and to better individualize treatment.
Cristina Encinas, MD, Hospital General Universitario Gregorio Marañón (Spain), and colleagues analyzed a large series of transplant- and non-transplant-eligible patients with multiple myeloma for risk of severe infection and the variables associated with infection in order to propose a risk prediction score of early severe infection. Researchers identified four Spanish Myeloma Group clinical trials (GEM2005 > 65, GEM2005 < 65, GEM2010, and GEM2012) involving 1347 patients to include in the study. Risk of severe infection was evaluated by CTCAE v4.0.
Researchers noted that 37.1% (n = 500) of patients were non-transplant eligible. The median follow-up among patients in these studies was 49 months.
Thirty-eight percent (n = 522) of patients reportedly experienced at least one infection. The total number of any grade infectious events was 963, of which 61.7% were of the respiratory tract. Dr Encinas and colleagues noted that 37.5% (n = 361) of infectious events were considered severe, including 168 cases of pneumonia. Incidence of severe infection at 12 months was 16.2%, and half of these patients suffered their first severe infection episode in the first 4 months after diagnosis.
Researchers included albumin, ECOG > 1, male sex, and non-IgA-type disease in a multivariate analysis. A simple score that allots one point each to includes albumin < 30 g/L, ECOG > 1, male sex, and non-IgA-type myeloma characterized patients into three risk groups for probability of severe infection with the first 4 months of diagnosis: low risk (points, 0-2), medium risk (points, 3), and high risk (points, 4).
When testing the validity of their risk prediction score, researchers found that the hazard ratio was 2.89 (95% CI, 1.98-4.23; P < .0001) after combining the medium- and high-risk groups.
In their concluding remarks, authors of the study wrote that, “Male sex, ECOG > 1, non-IgA-type disease, and serum albumin < 30 g/L permit to discriminate three patients subgroups with different risk of early severe infection.”—Zachary Bessette
