Introduction: Infections are additional factors of morbidity and mortality in multiple myeloma (MM), and the current recommendation is antibiotic prophylaxis. In sub-Saharan Africa, few data on infectious complications of MM are available. We aim to describe the microbiological features of infections in MM, and their impact on survival in Senegalese patients. Methods: A retrospective (January 2005-January 2022), analytic, multicenter study on infections in patients followed for MM (IMWG criteria) in Senegalese clinical hematology services. The socio-epidemiological, diagnostic, microbiological, evolutionary and survival aspects were analyzed. Results: The study included 106 patients with multiple myeloma who had an infection at admission or during the treatment. Ten patients have the comorbidity (hypertension, lupus, type 2 diabetes). These patients had 136 infectious events identified at diagnosis (79.2%) or during chemotherapy (20.8%). The sites of infection are lung (42.6%), urinary (29.4%), dermatological (6.6%), digestive (5.2%), osteoarticular (4.4%), ear, nose and throat (3.7%), central nervous system (1.5%), or without site. We recorded 26.4% of patients with multi-site infections. The causal pathogens are bacteria (Gram-negative bacilli: 22.1%; Gram positive bacilli: 9.5%, Mycobacterium tuberculosis: 13.3%), parasitique (plasmodium falciparum 6.6%), viruses (SARS-COV2: 2.9%, VZV: 2.2%) and fungal (2.9%). Survival was reduced in patients who had an infection at the time of multiple myeloma diagnosis (p: 0.189) and those who had multiple infectious foci (p: 0.011). Conclusion: Infections in multiple myeloma are more frequent at diagnosis. The germs are varied and mostly bacteria, particularly gram-negative bacteria, and Koch’s bacillus. Our study reveals that multiple infectious foci are a poor prognosis factor. It is necessary to evaluate the infectious risk early, and to adopt an antibiotic prophylaxis based on our tropical environment.
References
[1]
Caro, J., Braunstein, M., Williams, L., Bruno, B., Kaminetzky, D., Siegel, A., et al. (2022) Inflammation and Infection in Plasma Cell Disorders: How Pathogens Shape the Fate of Patients. Leukemia, 36, 613-624. https://doi.org/10.1038/s41375-021-01506-9
[2]
Raje, N.S., Anaissie, E., Kumar, S.K., Lonial, S., Martin, T., Gertz, M.A., et al. (2022) Consensus Guidelines and Recommendations for Infection Prevention in Multiple Myeloma: A Report from the International Myeloma Working Group. The Lancet Haematology, 9, E143-E161. https://doi.org/10.1016/S2352-3026(21)00283-0
[3]
Augustson, B.M., Begum, G., Dunn, J.A., Barth, N.J., Davies, F., Gareth Morgan, G., et al. (2005) Early Mortality after Diagnosis of Multiple Myeloma: Analysis of Patients Entered onto the United Kingdom Medical Research Council Trials between (1980) and 2002—Medical Research Council Adult Leukaemia Working Party. Journal of Clinical Oncology, 23, 9219-9226. https://doi.org/10.1200/JCO.2005.03.2086
[4]
Gracia Escudero, A., Martin, Gonzalez, M., Gimenez Garrido, F., et al. (2003) A Prospective, Controlled, Non-Randomized Study of Three Cohorts to Test the Effectiveness of Two Antibiotics Levofloxacin and Cotrimoxazol on Antibacterial Prophylaxis in Neutropenic Patients. MedicinaClínica (Barc), 15, 321-325. https://doi.org/10.1016/S0025-7753(03)73691-4
[5]
Tolo, D.A., Sawadogo, D., Nanho, D.C., Kouakou, B., Méité, N., Ayémou, R., et al. (2013) Characteristics and Results of the Treatment of Multiple Myeloma in the Subject under the Age of 65 at the University Hospital of Yopougon in Abidjan, Côte d’Ivoire. Advances in Hematology, 2013, Article ID: 583051. https://doi.org/10.1155/2013/583051
[6]
Ngolet, L.O., Kocko, I., Atipo Tsiba Galiba, F.O., Ockouango, J. and Elira Dokekias, A. (2016) Parcours préhospitalier du patient ayant un myélome multiple à Brazzaville. Health Sciences and Disease, 17, 88-91.
[7]
Nwabuko, O.C., Igbigbi, E.E., Chukwuonye, I.I. and Nnoli, M.A. (2017) Multiple Myeloma in Niger Delta, Nigeria: Complications and the Outcome of Palliative Interventions. Cancer Management and Research, 9, 189-196. https://doi.org/10.2147/CMAR.S126136
[8]
Odunukwe, N.N., Madu, J.A., Nnodu, O.E., Okocha, O.E., Akingbola, T.S., Asuquo, I.M., et al. (2015) Multiple Myeloma in Nigeria: A Multi-Centre Epidemiological and Biomedical Study. The Pan African Medical Journal, 22, Article No. 292. https://doi.org/10.11604/pamj.2015.22.292.7774
[9]
Manyega, K.M., Lotodo, T.C., Oduor, M.A., Namaemba, D.F., Omondi, A.A., Oyolo, Y.L., et al. (2021) Retrospective Analysis of Presentation, Treatment, and Outcomes of Multiple Myeloma at a Large Public Referral Hospital in Eldoret, Kenya JCO. Global Oncology, 7, 391-399. https://doi.org/10.1200/GO.20.00573
[10]
International Myeloma Working Group (2003) Criteria for the Classification of Monoclonal Gammopathies, Multiple Myeloma and Related Disorders: A Report of the International Myeloma Working Group. British Journal of Haematology, 121, 749-757. https://doi.org/10.1046/j.1365-2141.2003.04355.x
[11]
Rajkumar, S.V., Dimopoulos, M.A., et al. (2014) International Myeloma Working Group Updated Criteria for the Diagnosis of Multiple Myeloma. The Lancet Oncology, 15, E538-E548. https://doi.org/10.1016/S1470-2045(14)70442-5
[12]
Durie, B.G. and Salmon, S.E. (1975) A Clinical Staging System for Multiple Myeloma: Correlation of Measured Myeloma Cell Mass with Presenting Clinical Features, Response to Treatment, and Survival. Cancer, 36, 842-854. https://doi.org/10.1002/1097-0142(197509)36:3<842::AID-CNCR2820360303>3.0.CO;2-U
[13]
Greipp, P.R., San Miguel, J., Durie, B.G.M., Crowley, J.J., Bartogie, B., Bladé, J., et al. (2005) International Staging System for Multiple Myeloma. Journal of Clinical Oncology, 23, 3412-3420. https://doi.org/10.1200/JCO.2005.04.242
[14]
Kyle, R.A. and Rajkumar, S.V. (2009) Criteria for Diagnosis, Staging, Risk Stratification and Response Assessment of Multiple Myeloma. Leukemia, 23, 3-9. https://doi.org/10.1038/leu.2008.291
[15]
Seynabou, F., Dieng, F., Diouf, C., Djiba, B., Ndao, A.C. and Diago Ndiaye, F.S. (2017) Profil diagnostique et évolutif du myélome multiple au Sénégal: Étude monocentrique de 2005 à 2016. The Pan African Medical Journal, 27, Article No. 262. https://doi.org/10.11604/pamj.2017.27.262.13164
[16]
Okello, C.D., Mulumba, Y., Omoding, A., Ddungu, H., Welch, K., Thompson, CL., et al. (2021) Characteristics and Outcomes of Patients with Multiple Myeloma at the Uganda Cancer Institute. African Health Sciences, 21, 67-74. https://doi.org/10.4314/ahs.v21i1.11
[17]
Valković, T., Gačić, V., Ivandić, J., Petrov, B., Dobrila-Dintinjana, R., Dadić-Hero, E., et al. (2015) Infections in Hospitalised Patients with Multiple Myeloma: Main Characteristics and Risk Factors. Turkish Journal of Hematology, 32, 234-242. https://doi.org/10.4274/tjh.2013.0173
[18]
Kiraka, G., Etabale, M. and Riyat, M. (2014) A Review of 74 Patients with Newly Diagnosed Multiple Myeloma at a Tertiary Referral Hospital in Nairobi, Kenya. Journal Africain du Cancer, 6, 70-74. https://doi.org/10.1007/s12558-013-0294-5
[19]
Teh, B.W., Harrison, S.J., Worth, L.J., Spelman, T., Thursky, K.A. and Slavin, M.A. (2015) Risks, Severity and Timing of Infections in Patients with Multiple Myeloma: A Longitudinal Cohort Study in the Era of Immunomodulatory Drug Therapy. British Journal of Haematology, 171, 100-108. https://doi.org/10.1111/bjh.13532
[20]
Mikulski, D., Robak, P., Ryżewska, W., Stańczak, K., Kościelny, K., Góra-Tybor, J., et al. (2022) Risk Factors of Infection in Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide and Dexamethasone (Rd) Regimen: Real-Life Results of A Large Single-Center Study. Journal of Clinical Medicine, 11, Article 5908. https://doi.org/10.3390/jcm11195908
[21]
Zahid, M.F., Ali, N., Nasir, M., Baig, M.H., Iftikhar, M., Bin, Mahmood, S.U., et al. (2019) Infections in Patients with Multiple Myeloma Treated with Conventional Chemotherapy: A Single-Center, 10-Year Experience in Pakistan. Hematology, Transfusion and Cell Therapy, 41, 292-297. https://doi.org/10.1016/j.htct.2019.02.005
[22]
Chari, A., Samur, M.K., Martinez-Lopez, J., Cook, G., Biran, N., et al. (2020) Clinical Features Associated with COVID-19 Outcome in Multiple Myeloma: First Results from the International Myeloma Society Data Set. Blood, 136, 3033-3040. https://doi.org/10.1182/blood.2020008150
[23]
Djebbari, F., Panitsas, F., Eyre, TA., Prodger, C., Davies, F., Burton, K., et al. (2020) Infection-Related Morbidity in A Large Study of Transplant Non-Eligible Newly Diagnosed Myeloma Patients Treated with UK Standard of Care. Haematologica, 105, E474-E479. https://doi.org/10.3324/haematol.2019.240762
