Incidence and risk factors for bacterial infection using bortezomib, lenalidomide, and dexamethasone (RVd) in newly diagnosed multiple myeloma

Abstract

Infections are an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the real-world risk using modern induction regimens such as bortezomib, lenalidomide, and dexamethasone (RVd) is not well described. We performed a retrospective single-center cohort study to identify infections and risk factors in patients treated with first-line RVd from January 2014 to January 2020 and collected demographic and clinical data. Of 144 patients treated with RVd for NDMM, 21 patients (14.5%) experienced a bacterial infection during induction, of which 8 (5.5%) were grade 3 infections despite a low rate of antibiotic prophylaxis use (12%). Grade 3 neutropenia occurred in 11% of patients, 2% had febrile neutropenia and there were no deaths from infection. On multivariable analysis, age, smoking history, diabetes, antibiotic use in the 60 days preceding the start of RVd, and high-risk cytogenetics were associated with higher risk of bacterial infection.

Keywords:

• Infection
• multiple myeloma
• toxicity
• bacterial infections
• antibiotic prophylaxis
• pneumonia
• risk factors

Acknowledgments

The authors would like to acknowledge Moshe Talpaz MD, Malathi Kandarpa, PhD, and Avery Polk, BS for providing patient-level data from the University of Michigan Multiple Myeloma patient database for this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institutes of Health: National Institute of Aging under grant P30-AG024824, M.J.P.; National Cancer Institute under P30-CA046592, M.J.P.; and National Center for Advancing Translational Sciences under UL1-TR00457, M.J.P, and the Rogel Cancer Center Young Clinical Investigator Award (M.J.P.).