J Clin Med: Risk factors for infection in patients with relapsed/refractory multiple myeloma treated with lenalidomide and dexamethasone (Rd) regimens: real results from a large single-center study

Multiple myeloma (MM) is a hematologic malignancy characterized by abnormal growth of monoclonal plasma cells, renal impairment, hypercalcemia, bone damage, and anemia
.
Lenalidomide-based regimens are an effective treatment option
for patients with relapsed/refractory multiple myeloma (RRMM).
However, they are associated
with an increased risk of infectious complications.
This study explores the clinical factors
influencing the development of infection in MM patients treated with lenalidomide and dexamethasone (Rd).

A retrospective analysis
was conducted on all patients who received the Rd regimen at our institution between 2017 and 2021.
The study group consisted of 174 patients with a median age of 65 years
.
Most patients (n = 110, 63.
2%) received Rd therapy
in the second line.
The majority of patients (64.
3%) received bortezomib-based regimens
in first-line therapy.

Figure 1.
Multivariate Cox regression analysis
for pre-feasibility study (A) and operating system (B).

The median progression-free survival was 12.
6 months (95% CI: 9.
5 to 16.
2) months and the median overall survival was 22.
3 months (95% CI: 15.
9 to 28.
6) months
.
The overall response rate was 64.
1%, with 12.
7% of patients achieving a complete response and 20.
4% of patients having a very good
partial response.

Figure 2.
Multiple logistic regression analysis of
infection occurrence during Rd treatment.

In multivariate logistic regression analysis, hypoalbuminaemia (OR 4.
2, 95% CI: 1.
6–11.
2, p = 0.
0039), autologous hematopoietic stem cell transplantation (AHSCT) prior to Rd (OR 2.
6, 95% CI: 1.
0–6.
7, p = 0.
048), and anaemia≥3 (OR 5.
0, 95% CI: 1.
8–14.
0, p = 0.
002) is an independent factor
associated with the development of infection.

In summary, the study examined a large group of MM patients
treated with the Rd regimen.
The results of the study identified AHSCT before treatment with the Rd regimen, hypoalbuminemia and anemia during treatment as three independent factors
affecting the frequency of infection during Rd treatment in a large number of RRMM patients.
Among the infections affecting treatment, the most common are upper respiratory tract infections, pneumonia, and urinary tract infections
.
AHSCT is a recognized factor
associated with an increased risk of infection.
Patients with AHSCT are more susceptible to viral reactivation and develop more severe viral infections
.
It is also suggested that patients with known risk factors may benefit from optimal supportive care, including erythropoietin-stimulating drugs and antimicrobial prophylaxis
.

Original source:

Mikulski D, Robak P, Ryżewska W, et al.
Risk Factors of Infection in Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide and Dexamethasone (Rd) Regimen: Real-Life Results of a Large Single-Center Study.
J Clin Med.
2022; 11(19):5908.
Published 2022 Oct 7.
doi:10.
3390/jcm11195908