title: Changing treatment paradigms for patients with plasma cell myeloma: impact upon immune determinants of infection.
abstract: Plasma cell myeloma (PCM) is increasing in prevalence in older age groups and infective complications are a leading cause of mortality. Patients with PCM are at increased risk of severe infections, having deficits in many arms of the immune system due to disease and treatment-related factors. Treatment of PCM has evolved over time with significant impacts on immune function resulting in changing rates and pattern of infection. Recently, there has been a paradigm shift in the treatment of PCM with the use of immunomodulatory drugs and proteasome inhibitors becoming the standard of care. These drugs have wide-ranging effects on the immune system but their impact on infection risk and aetiology remain unclear. The aims of this review are to discuss the impact of patient, disease and treatment factors on immune function over time for patients with PCM and to correlate immune deficits with the incidence and aetiology of infections seen clinically in these patients. Preventative measures and the need for clinically relevant tools to enable infective profiling of patients with PCM are discussed.
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Teh
authors.affiliation: Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Harrison
authors.affiliation: Walter and Eliza Hall Institute for Medical Research, Parkville, Australia.
authors.forename: Marc
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Thursky
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Australia.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000276:immunology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007239:Infections / Q000209:etiology; D009101:Multiple Myeloma / Q000150:complications / Q000276:immunology / Q000628:therapy*; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
keywords: Immune deficit; Infection; Myeloma; Treatment