Why are newly diagnosed myeloma patients at risk of infection?
Okay, So newly diagnosed myeloma patients, as I've mentioned, are already at some increased risk of infection. When we start treatment, we're also almost certainly increasing their risk of infection further. And so I think it's important for patients to pay close attention to how they're feeling. I know that they have a thermometer at home, know that it has batteries and that it still works. And that they really pay attention to if they should develop a cold or some other kind of illness, that they communicate that. Newly diagnosed myeloma patients are often still getting treatments that have a lot of steroids in them. And the steroids can sometimes hide a fever. And so if a patient is feeling poorly but they don't have a fever, I still ask that they call us and talk it through because the steroids might be keeping them from having a temperature.
What precautions should NDMM patients take to prevent infection?
Prophylactic medications to help prevent infections for myeloma are usually chosen based on the treatment that a patient is going to be receiving. So even if a patient has myeloma, has some degree of immunosuppression, we don't usually start them on the prophylactic treatments until we start their treatment. Once we start treatment, we choose which drug to use based on which regimens are being given. Generally speaking, we're talking about antiviral treatments that can help prevent herpes zoster infection. Sometimes we're talking about different types of antibacterials based on the other medications that are used in the combinations.
How can vaccinations prevent infections?
Vaccinations are important in general to help maintain public health, but in the setting of cancer and in the setting of receiving cancer treatments, it's often difficult to predict how well a person is going to respond to a vaccine. I think that it's important to remain in really good contact with the health care team about what they're specifically recommending. In general, any kind of vaccine that's made with a live a live virus is not something that we want a patient to receive if they are immunosuppressed, because there is a risk that they could get an infection from that vaccine. Other vaccines, the risk of having a bad reaction to them is generally low compared to the potential risk of having an improvement in their immune system. So I generally err on the side of recommending that people get the vaccines. I try to lift the burden off of patients for trying to figure out the perfect time to get a vaccine in the midst of a treatment schedule. But I think people should really be talking to their doctors about it specifically.
What should I know about hand hygiene and infection prevention?
I think that handwashing with soap is just as good probably as hand-washing with those alcohol based sanitizers and things like that. I think that trying to maintain good habits of washing your hands before you prepare food and before you eat and after you've been out in the community or on public transit is very important. I think that people who live in families where there's young kids or or a lot of people coming and going, trying to set the habit of having individuals just wash their hands when they enter the home is very, very reasonable and very smart to do. So newly diagnosed myeloma patients who are at risk for infection Because at least the way I consider is think about your immune system like the armed forces. You know, you have the army, the Navy plasma cells are the cells that become malignant in myeloma, and the plasma cells are one of the key forces. And at the time of diagnosis, those are malignant. So they're not fighting infection. And think about it like you're at war every day. But if your plasma cells are gone, that's like saying, you know, our entire army is not there. You know, we still have the Navy, the Marines, the Air Force. But if you don't have the Army, you're going to be vulnerable at some level. Same thing with myeloma. If you don't have those plasma cells fighting infection, you'll lose that group of the immune system and you're just more predisposed.
HealthTree • July 13, 2025
