Patients with multiple myeloma (MM) face a high risk of infections, particularly in the early stages of diagnosis and during treatment. Infection risk is influenced by disease factors like high tumor burden and poor renal function, as well as treatment-related factors such as chemotherapy and stem cell transplantation. Preventive measures, including vaccination and broad-spectrum antibiotics, are crucial for managing this risk. The International Myeloma Working Group (IMWG) recommends early vaccination against Streptococcus pneumoniae, the use of antiviral agents like acyclovir, and individualized strategies based on the patient’s risk profile. Older adults and those with comorbidities require additional precautions, such as decolonization therapy for Staphylococcus aureus and targeted prophylaxis for previous infections.

The IMWG guidelines also recommend inactivated vaccines, intravenous immunoglobulin for severe infections, and immunoglobulin prophylaxis for exposures to varicella, herpes zoster, or hepatitis. Granulocyte colony-stimulating factors may be considered for certain patients, and education on hygiene, regional infection risks, and travel precautions is essential. An individualized infection prevention strategy is vital, especially for patients at higher risk for severe infections, to improve patient outcomes and reduce mortality.

Reference: Karakuleli G. IMWG recommendations for infections in multiple myeloma. Multiple Myeloma Hub. Published March 8, 2022. Accessed May 19, 2025. https://multiplemyelomahub.com/medical-information/imwg-recommendations-for-infections-in-multiple-myeloma