When you have multiple myeloma, infections are something you’ll need to watch out for. The disease and its treatment make infections more likely. If you get an infection, it’s also more likely to get worse because your immune system won’t work as well to fight it.
Infection is the cause of 22% of deaths in people with multiple myeloma. This is why it’s so important for you to know what steps to take to protect yourself against infection.
Why Do Infections Happen in Multiple Myeloma?
Multiple myeloma is a cancer that happens in certain white blood cells. Those cells, called plasma cells, normally help you fight infections. But when you have myeloma, those cells don’t act the way they should. Instead of making antibodies to fight infections, they make other abnormal proteins. They also build up in your bones and crowd out other cells your body needs.
Because of this, frequent infections are a common symptom of multiple myeloma. If you have multiple myeloma, you might not need treatment right away. Your doctor might watch to see how it’s growing and if you’re having symptoms. When it’s time for you get treatment, the drugs that help to fight the cancer can leave you even more prone to getting infections.
As myeloma treatments have gotten better, more people with myeloma are living longer. Multiple myeloma today has become a chronic condition. You may get better for a while and then relapse. Your immune system may get weaker over time. So finding ways to manage any problems with your immune system and your risk of infection is key to doing well.
Infections and Multiple Myeloma Stages
Your doctor will use tests to find out what stage or how advanced the cancer is. For multiple myeloma, one of the most important things your doctor will want to find out is if you’re having symptoms. If you aren’t having symptoms, you might not need treatment right away.
Infections aren’t one of the main symptoms doctors use to decide if you need treatment. But it’s still important to track them. If you’ve had recurring serious bacterial infections in the last year, it may be a sign that you need to start treatment for multiple myeloma.
While your risk of infection can increase over time, you’ll already be at high risk of infection in the first year after being diagnosed. One study found that people with myeloma got bacterial infections seven times more often than people without myeloma. You’re also 10 times more likely to get viral infections.
Some infections that are more likely when you have myeloma include:
- Infection in the fluid around your brain and spinal cord (meningitis)
- Blood poisoning by bacteria (sepsis or septicemia)
- Infection in one or both of your lungs (pneumonia)
- Infection in your bones (osteomyelitis)
- Infection in deep layers of your skin (cellulitis)
- Infection in your kidneys (pyelonephritis)
Multiple Myeloma and RSV Risk
If you have multiple myeloma, you are at higher risk of getting many viruses, including respiratory syncytial virus (RSV). While usually marked by mild, cold-like symptoms, RSV can be severe if your immune system isn’t working as well as it should be. With multiple myeloma, the disease suppresses the immune system, as do certain treatments. As a result, your body is less able to fend off RSV. In one study, people with both multiple myeloma and RSV had prolonged stays in the hospital.
Use commonsense precautions to minimize exposure to infections, says Hearn Hearn Jay Cho, MD, PhD, a clinical professor of medicine (hematology and medical oncology) at the Icahn School of Medicine at Mount Sinai in New York City and the chief medical officer of the Multiple Myeloma Research Foundation.
This includes hand-washing with soap and water, avoiding people who are sick, steering clear of large crowds during cold and flu season, and masking when crowds cannot be avoided or when traveling by public transportation.
RSV vaccine for multiple myeloma patients
The RSV vaccine can help fight off RSV or make your symptoms less severe if you get infected with this virus.
The CDC recommends a single dose of any approved RSV vaccine for all adults ages 75 and up and adults ages 50-74 who have a higher risk of severe RSV, including those who have multiple myeloma. The shot is also recommended for pregnant women and infants. The timing of the shot and your level of immunosuppression will affect how well it works.
Discuss your risk of RSV with your doctor and do all that you can to keep this and other infections at bay.
Multiple Myeloma and Shingles Risk
Multiple myeloma ups your risk of developing shingles, a painful rash that appears when the varicella-zoster virus (VZV), which causes chickenpox, gets reactivated. Your risk is higher due to the nature of multiple myeloma. Some treatments for multiple myeloma weaken your immune system’s ability to ward off illnesses like shingles.
Your doctor may suggest taking preventive antivirals such as acyclovir or valacyclovir to lower your chances of getting shingles during your myeloma treatment.
Shingles vaccine for multiple myeloma patients
Getting the shingles shot can help prevent the painful blistering caused by the immune-suppressing nature of both the cancer and its treatments.
Given as a two-dose series, the recombinant zoster (shingles) vaccine is recommended for:
- Adults ages 50 and older
- Adults ages 19 and older who have a weakened immune system
Multiple Myeloma and Your Age
Multiple myeloma happens most when you’re 60 and up. Few people with myeloma are under 40, but it does happen. One study found that infections in people with myeloma are happening more in recent years than they used to in people of all ages. The researchers think this is a sign that new treatments come with added infection risk.
They found that the risk has gone up both in people with myeloma who were older and younger. Younger people with myeloma may more often get newer treatments or stem cell transplants. Doctors don’t know for sure, but these treatments might help to explain the increase in infections in younger people with myeloma. Ask your doctor about the risk of infection related to any treatment you’re receiving for your myeloma.
How Are Infections Treated in Multiple Myeloma?
If you have an infection from bacteria, your doctor will need to treat it with antibiotics as soon as they can. You’ll probably have a fever. Your doctor might also have you take antibiotics regularly to make it less likely you’ll get an infection in the first place. One antibiotic they might use for this is trimethoprim-sulfamethoxazole (Bactrim or Septra). If you get infections a lot, you might take penicillin every day.
Some people with multiple myeloma also get infusions with antibodies that are found in the plasma from plasma donors. These infusions are called gamma globulin. Usually, you won’t need this, but you could ask your doctor about it if you think you’re getting infections too much.
What Are Other Ways to Prevent Infection in Multiple Myeloma?
You can take other steps to make infections less likely to happen. This will include getting your vaccines. You should get your regular flu vaccine to help keep you from getting influenza. The pneumococcal vaccine will lower your risks of getting pneumonia.
Doctors also recommend that all people with myeloma get vaccinated against COVID-19. You should follow guidance for people with a compromised immune system. This means you’ll need more doses of the vaccine to help you stay more protected. Ask your doctor if there are any other vaccines you should get.
You can take lots of other steps to help lower your infection risk. These include:
- Wash your hands a lot with soap and water. Wash them for at least 20 seconds each time you do.
- Carry alcohol-based sanitizer to keep your hands clean when you can’t wash them with soap and water.
- Don’t touch your face when your hands haven’t just been washed.
- Be careful about spending time with anyone who might be sick.
- Keep 6 feet between you and other people when you are out in public places or around a lot of people.
- Don’t go to parties or other large social gatherings.
- Wear a well-fitting mask that covers your mouth and nose when you’re in a place with other people indoors.
- Don’t travel when you can help it, especially in an airplane or cruise ship.
- Avoid places where you know viral illnesses, including COVID-19, are spreading a lot.
- Drink lots of water and exercise.
Watch for These Signs of Infection
When you have multiple myeloma, it’s a good idea to watch for any signs of infection or illness. Call your doctor if you get a fever, especially if you're getting chemotherapy to treat cancer. Infections can have lots of symptoms, but sometimes a fever is the only one.
Other signs of an infection may include:
- Chills or sweats
- Coughing
- Sore throat
- Trouble breathing
- Congestion
- Stiff neck
- Pain or burning when you pee
- Vaginal discharge or irritation
- Peeing more often
- Redness, soreness, or swelling in any part of your body
- Diarrhea
- Throwing up
- Belly pain
- Any new pain
An infection when you have multiple myeloma, whether you’re in treatment or not, can be fatal. Many people with myeloma don’t die from cancer but from an infection. To help you catch it quickly if you have an infection, follow these steps:
- Take your temperature if you don’t feel well or think you may be warm.
- Always have a thermometer with you so you can check your temperature.
- Call your doctor if you have a fever or temperature of at least 100.4 F or any other new symptom that could mean an infection.
- Ask your doctor how high your risk is based on your cancer stage or other factors and what steps you should take to protect yourself.
- Carry your doctor’s contact information with you and know how to reach someone quickly at any time.
- If you decide you need to go to an emergency room or other clinic, tell the doctor and others at the clinic about your multiple myeloma and infection risk.
Takeaways
Multiple myeloma increases your risk of getting bacterial and viral infections such as the flu, RSV, and shingles. The increased risk is due to the immune-suppressing nature of the disease itself and treatments. Taking steps to stave off infection, including proper hand-washing and staying up to date on vaccines, can help lower your chances of getting sick.
FAQs About Multiple Myeloma and Infection
Below are some of the most commonly asked questions about multiple myeloma and infection.
What is the most common infection in multiple myeloma patients?
There is not one most common infection in people with multiple myeloma, Cho says. “You are vulnerable to a lot of different kinds of infections, including bacterial infections such as pneumonia, and viral ones, including RSV and soft tissue infections.”
Can a virus or bacteria cause multiple myeloma?
This has been hotly debated and widely studied in the myeloma community, and the short answer is no, says Cho. “To date, there is no definitive evidence that any infectious disease causes multiple myeloma.”
What are the signs of myeloma getting worse?
Your doctor will routinely monitor your blood for signs that your myeloma is getting worse during and after treatment. Bloodwork is usually the first sign that the disease is progressing, but sometimes when the myeloma is aggressive, symptoms such as new bone pain or fractures may be the tell, Cho says.
