A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma
Cristina Encinas # 1 , José-Ángel Hernandez-Rivas # 2 , Albert Oriol 3 , Laura Rosiñol 4 , María-Jesús Blanchard 5 , José-María Bellón 1 , Ramón García-Sanz 6 , Javier de la Rubia 7 , Ana López de la Guía 8 , Ana Jímenez-Ubieto 9 , Isidro Jarque 10 , Belén Iñigo 11 , Victoria Dourdil 12 , Felipe de Arriba 13 , Clara Cuéllar Pérez-Ávila 9 , Yolanda Gonzalez 14 , Miguel-Teodoro Hernández 15 , Joan Bargay 16 , Miguel Granell 17 , Paula Rodríguez-Otero 18 , Maialen Silvent 19 , Carmen Cabrera 20 , Rafael Rios 21 , Adrián Alegre 22 , Mercedes Gironella 23 , Marta-Sonia Gonzalez 24 , Anna Sureda 25 , Antonia Sampol 26 , Enrique M Ocio 27 , Isabel Krsnik 28 , Antonio García 29 , Aránzazu García-Mateo 30 , Joan-Alfons Soler 31 , Jesús Martín 32 , José-María Arguiñano 33 , María-Victoria Mateos 6 , Joan Bladé 4 , Jesús F San-Miguel 18 , Juan-José Lahuerta 9 , Joaquín Martínez-López 34 , GEM/PETHEMA (Grupo Español de Mieloma/Programa para el Estudio de la Terapéutica en Hemopatías Malignas) cooperative study group
Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures.
We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis.
The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM.
A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.