title: Infectious complications in patients with multiple myeloma treated with new drug combinations containing thalidomide.
abstract: The literature provides scant data concerning infectious complications and their effect on the outcome of patients with multiple myeloma (MM) treated with new drug combinations. Despite no substantial myelotoxic effect, thalidomide increases the risk of severe infections in patients with MM. We studied 202 patients who received regimens containing thalidomide in order to assess the time, type, outcome, and factors affecting development of severe infections, role of antibiotic prophylaxis, and effect of severe infections on final outcome. Thirty-eight patients (19%) developed a severe infection early during induction therapy and most infections were pneumonia. Only one patient died due to septic shock during neutropenia. No significant differences were reported in terms of progression-free survival (PFS) and overall survival (OS) between patients developing a severe infection and those who did not. Multivariate analysis determined a monoclonal component >3 g/dL and platelets <130 ,000/μL as factors associated with increased risk of severe infection. Primary antibiotic prophylaxis significantly decreased the probability of severe infection only in patients having both the above risk factors. Patients with MM receiving thalidomide combinations with high tumor burden are at high risk of developing severe infections and require primary antibiotic prophylaxis, whereas in other patients it is questionable. However, patient final outcome was not affected by infection development.
authors.affiliation: Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy. m.offidani@ospedaliriuniti.marche.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Laura
authors.initials: L
authors.lastname: Corvatta
authors.forename: Claudia
authors.initials: C
authors.lastname: Polloni
authors.forename: Silvia
authors.initials: S
authors.lastname: Gentili
authors.forename: Annamaria
authors.initials: A
authors.lastname: Brioni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Piero
authors.initials: P
authors.lastname: Galieni
authors.forename: Marino
authors.initials: M
authors.lastname: Brunori
authors.forename: Francesco
authors.initials: F
authors.lastname: Alesiani
authors.forename: Massimo
authors.initials: M
authors.lastname: Catarini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Centurioni
authors.forename: Arduino
authors.initials: A
authors.lastname: Samori
authors.forename: Nicola
authors.initials: N
authors.lastname: Blasi
authors.forename: Mario
authors.initials: M
authors.lastname: Ferranti
authors.forename: Paolo
authors.initials: P
authors.lastname: Fraticelli
authors.forename: Anna
authors.initials: A
authors.lastname: Mele
authors.forename: Rita
authors.initials: R
authors.lastname: Rizzi
authors.forename: Federica
authors.initials: F
authors.lastname: Larocca
authors.forename: Pietro
authors.initials: P
authors.lastname: Leoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000150:complications / Q000209:etiology / Q000517:prevention & control; D011336:Probability; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D013792:Thalidomide