973P - Pretreatment lymphopenia and poor performance status are risk factors of severe bacterial infection in patients with multiple myeloma during chemot...

Abstract

Aim

Infection is the leading cause of morbidity and mortality in patients with multiple myeloma. The aim of this study is to identify the risk factors associated with the development of severe infections in patients with multiple myeloma during chemotherapy with bortezomib-containing regimens.

Methods

A total of 98 patients with myeloma who were treated with bortezomib-based chemotherapy between 2006 and 2012 were examined. Using the logistic regression method, a variety of factors were analyzed for the development of severe bacterial infections (SBI) at each of 427 courses.

Results

Median age of patients was 62 years, and 40.6% (30/98) of patients were treated with bortezomib-containing chemotherapy as first-line treatment. The SBI was developed in 57% (56/98) of patients and 19% (81/427) of bortezomib courses. Of 81 SBI episodes, 42 (53%) episodes were clinically documented infection, 30 (37%) episodes were microbiologically documented infections, and 9 (11%) episodes were fever of unknown origin. Multivariate logistic regression analysis revealed poor performance status (ECOG ≥2) (HR 3.920, 95% C.I. 2.305-6.666, P <.001), early courses of therapy (≤2 courses) (HR 2.782, 95% C.I. 1.633-4.740, P <.001) and pretreatment lymphopenia (HR 1.728, 95% C.I. 1.016-2.937, P = .043) as risk factors for development of SBI during the chemotherapy with bortezomib containing regimens. The probability of SBI at each course was 5.1% in courses with no risk factor, 14.9% with 1 risk factor, 23.9% with 2 risk factors and 59.5% with 3 risk factors (P <.001). Interestingly, patients who experienced SBI showed a significantly shorter overall survival than patients who didn't experienced SBI (median 6.1 month vs 30.1 months, P = .004) although progression free survival was not different (median 18.1 months vs 21.9 months, P = .418). The multivariate Cox analysis demonstrated that the development of SBI was associated with inferior overall survival (HR 2.440, 95% C.I. 1.305-4.561, P = .005), as well as male sex (HR 2.323, 95% C.I. 1.236-4.367, P = .009).

Conclusions

Patients with these risk factors (early courses of therapy, poor performance status and lymphopenia) should be more closely monitored for bacterial infections and a consideration of prophylactic use of antibiotics at least for the initial 2 courses of therapy would be helpful to decrease bacterial infections.

Disclosure

All authors have declared no conflicts of interest.