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. 2025 Jan 1;110(1):163-172.
doi: 10.3324/haematol.2024.285645.

Risk of infections in multiple myeloma. A populationbased study on 8,672 multiple myeloma patients diagnosed 2008-2021 from the Swedish Myeloma Registry

Cecilie Hveding Blimark  1 , Kristina Carlson  2 , Christopher Day  3 , Sigrun Einarsdottir  3 , Gunnar Juliusson  4 , Moshtak Karma  5 , Dorota Knut-Bojanowska  6 , Gunnar Larfors  2 , Ingemar Turesson  7 , Mariana Villegas-Scivetti  3 , Ingigerdur Sverrisdóttir  8
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Risk of infections in multiple myeloma. A populationbased study on 8,672 multiple myeloma patients diagnosed 2008-2021 from the Swedish Myeloma Registry

Cecilie Hveding Blimark et al. Haematologica. .

Abstract

In multiple myeloma (MM), advancements in treatments and toxicity management have enhanced survival rates. This, coupled with shifting age demographics in MM, necessitates an updated assessment of infection risks in MM patients compared to the general population. Using Swedish population-based registries, we investigated the incidence of infections in 8,672 Swedish symptomatic MM patients diagnosed 2008-2021 and 34,561 matched controls. Overall, MM patients had a 5-fold risk (hazard ratio [HR] =5.30; 95% confidence interval [CI]: 5.14-5.47) of developing a clinically significant infection compared to matched controls. Bacterial infections represented a 5-fold (HR=4.88; 95% CI: 4.70-5.07) increased risk, viral and fungal infections 7-fold compared to controls. The first year after MM diagnosis the risk of infections compared to controls was 7-fold (HR=6.95; 95% CI: 6.61-7.30) and remained elevated up to 5 years after the myeloma diagnosis. The risk of infection compared to controls remained 5-fold in MM patients with follow-up till 2022. Preceding MM diagnosis, the risk compared to matched controls was significantly increased up to 4 years before MM diagnosis (HR=1.16; 95% CI: 1.05-1.28). Among MM patients, 8% had died within 2 months of diagnosis and infection contributed to 32% of all deaths. After 1 year, 20% MM patients had died, and infection-related mortality was 27%. Our data constitute the largest population-based study to date on the risk of infections compared to the normal population in the era of modern MM therapies and confirms that infections still represent a major threat to patients and underscores importance of preventive strategies.

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Figures

Figure 1.
Figure 1.
Consort diagram of the MMBaSe study (Multiple MyelomaBaSe); a linked database from population-based registers in Sweden.
Figure 2.
Figure 2.
Incidence of infections before multiple myeloma diagnosis and over time in patients and controls. (A) In multiple myeloma (MM) patients, (B) MM patients with previously known smoldering multiple myeloma and (C) MM patients with previously known monoclonal gammopathy with undetermined significance.
Figure 3.
Figure 3.
Cumulative incidence of infection in multiple myeloma patients compared to controls.
Figure 4.
Figure 4.
Risk of death from infection or other causes in multiple myeloma patients and controls in a competing risk analysis.
See this image and copyright information in PMC

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