What can myeloma patients do to lessen their risk of getting a serious infection?

What can myeloma patients do to lessen their risk of getting a serious infection? How can infections be mitigated?

This is an incredibly important question because it really gets at the quality of life issues that we have to struggle with in a myeloma clinic with our patients, trying to help them enjoy the life that they've got while also struggling with the treatments that we're giving them.I like to tell my patients, “I don't want you living in a hamster ball. I want you out with your family and with your friends.” But of course, if COVID’s taught us nothing, we have to be very careful about how it is that we expose ourselves to various illnesses in the community.

I think what it comes down to is usually common sense. Are the people you're going to go hang out with sick? Are they going to safeguard your health and think about that? As opposed to, “I just really want to go to dinner,” you know, going to- going to dinner is great. Going out with friends is perfect. Maybe sometimes outdoor dining is better in the current era than going indoor dining. Going to the Early Bird Special on a Wednesday afternoon as opposed to a Friday night date night when you've got the whole crowd packed. And same with movies. But it is a big challenge.

And again, I don't think that we should be giving every single patient that we've got antibiotics, for example, across the board. And we know that that causes problems with the microbiome and we know that that causes problems with resistant infections. So that's not the right answer. Some patients benefit from maneuvers like IVIG or intravenous immunoglobulin, but not everybody. So I think really it's about good communication with your family and friends, making decisions that are helping you balance that quality of life and spending time with family and friends in these various situations versus what are the likelihood of people coming in with infections that don't even know they have and then having that good communication and understandingthat, well, if you are sick, maybe this isn't the time that we hang out. Let's get back together in a couple of weeks and having those frank discussions with family and friends as well.

In terms of cuts and scrapes. I mean, this is nothing magic here, right? This is the usual stuff. If you've got scrapes on the arm or especially if it's a cut, that's really bleeding, right? Just stop the bleeding. Make sure it's good, it's nice and clean with soap and water and we don't have to go crazy. But medications like dexamethasone
make the wounds healing slower, make the skin a little bit easier to cut open or scrape open. So you just may notice that over time that in addition to just getting older and having the skin be much more easily broken, that the meds like dexamethasone also contribute to that as well. So being really smart about just making sure that the wounds get cleaned in a timely fashion, that the bleeding gets stopped in a in a timely fashion is important. And then if there's any sort of redness or streaking up from a wound like that, that you just talk to your doctor really quickly.

I think first and foremost, I should start by saying that vaccines save lives in case of myeloma. And this is true for many different vaccines, including pneumonia vaccines, influenza vaccines, not to mention COVID vaccines, which are extremely important in our patient population with myeloma to vaccinate all of them. And it is extremely important to stay up to date with this dosages. Annual influenza vaccines, pneumonia vaccines every five years are strongly recommended. And there are a number of studies that have documented that these vaccines can help prevent severe infections, and they save lives in myeloma.

The other important factor is monitoring and watching the white blood cell count. So patients usually during treatment, undergo frequent bloodwork. The frequency may vary depending on the state in which they are, whether it's being observed or actively treated. During the course of active treatment, we normally monitor blood counts at least once monthly, if not once weekly. And when neutrophil count goes down to the dangerously low levels, this is the time to administer white blood cell growth factor to help prevent infections. Beyond that, obviously, common sense is recommended to all of our patients at risk for infections,
especially in the COVID era, avoiding crowded spaces, wearing masks in appropriate places where it's crowded and good hand hygiene, and sanitization, etc.