Why Are Infections Common In Myeloma As It Progresses? 

Infections are one of the most common and serious complications for people living with multiple myeloma. But some people with myeloma are at a higher risk of infection than others. 

To better understand how to predict infection risk, researchers studied 2,150 people with multiple myeloma. They looked at factors that help identify who was at the highest risk and how it changes as cancer progresses. This research could help identify early signs of infection risk and prevent complications. 

Why are infections so common in multiple myeloma?

Multiple myeloma is a type of blood cancer. It affects the plasma cells. These are a type of white blood cell that are a part of the immune system. In people with myeloma, plasma cells do not work the way they should, damaging the immune system.

In this study, researchers analyzed bone marrow and blood samples from 2,150 patients across different stages of myeloma. The results confirmed that infection risk increases as myeloma progresses, and more serious infections become more common in later stages. They found infections occurred in:

• 13% in early precursor disease (MGUS)
• 19% in smoldering myeloma
• 47% in newly diagnosed MM
• 54% in relapsed or refractory MM

Infections become more common as myeloma progresses because both the cancer itself and treatments weaken the immune system over time. 

How does the immune system change as myeloma progresses?

The study found that immune changes can begin even before active myeloma develops. As patients moved from precursor conditions to newly diagnosed and relapsed myeloma, researchers observed:

• A steady decline in normal B cells and memory B cells
• Fewer early blood-forming cells (hematopoietic progenitors)
• An increase in certain T-cell imbalances
• Expansion of monocytes (another immune cell type)

Interestingly, these immune differences were seen even when patients were the same age. This suggests that immune “aging” in myeloma may not simply be related to chronological age.

What tests were used to detect high risk of infection?

The researchers identified specific immune features linked to infection risk, called “Immune risk score”, and patients with two or more of these immune risk factors had a significantly higher infection risk compared to those with one or none (60% vs. 37%).

• Fewer memory B cells
• Fewer CD27-negative natural killer (NK) cells
• A higher ratio of CD27-negative to CD27-positive T cells

Many of these biomarkers can be monitored with blood tests, which are far less invasive than bone marrow biopsies.

This study is one of the largest studies ever conducted examining immune profiles in multiple myeloma 

In the future, immune profiling could help doctors identify higher-risk patients earlier and personalize infection-prevention plans, such as vaccination timing, antimicrobial prophylaxis, or treatment adjustments.

You can prevent infections at any stage by staying informed and detecting the first symptoms 

This study helped explain three main things: 

• Why infection risk increase over time
• How does immune function change at each stage of the disease
• Which patients may need closer monitoring or preventive strategies

Being aware of your own symptoms, communicating your concerns with your team, and staying informed about possible warning signs can help you and your team identify risk factors and prevent complications.   

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Source: Immune biomarkers of increased risk of infection in multiple myeloma (MM)