Infection risk in myeloma: Vaccinations, prophylaxis, and ER care
Fact-checked by The blood cancer myeloma and its therapies significantly increase a person’s vulnerability to infections. Because of this high risk, a myeloma diagnosis typically prompts doctors to recommend specific vaccines and preventive strategies to help ward off infectious complications.
These infections can quickly become dangerous for myeloma patients and remain a leading cause of complications and death. For this reason, individuals should report any potential signs of infection to their oncology team as soon as they appear.
Why myeloma raises the risk of infection
Myeloma happens when abnormal plasma cells in the bone marrow grow out of control. Plasma cells are antibody-producing immune cells that normally help the body fight infection.
In myeloma, these cancerous plasma cells do not work properly. Instead, they make ineffective antibodies that fail to protect the body, while also crowding out healthy plasma cells and other important immune cells.
Ultimately, this crowding leads to a shortage of functional immune cells and lowers the body’s defenses against harmful invaders. Consequently, people with myeloma may get sick more easily, and infections that would be mild in most people can become severe.
The immune system becomes increasingly compromised as the disease advances. However, it may somewhat recover when the cancer goes into remission and is under control.
How treatment can weaken immune defenses
While people with myeloma are already immunocompromised from the disease, treatments used to manage the cancer can further exacerbate a weakened immune system.
Many cancer treatments are designed to kill fast-growing cells, including cancer cells. Because some healthy cells in the body also grow rapidly, these treatments can damage them. Immune cells are among these fast-growing cell types, and losing them makes it harder for the body to fight off illness. Immune cells called neutrophils, which act as first responders to infection or injury, are often particularly affected by treatment.
Some treatments are more likely than others to impact the immune system. For instance, people who receive a stem cell transplant are particularly vulnerable. Patients should talk with their care team about what to expect with their specific regimen.
Vaccines and preventive medications
After a myeloma diagnosis, doctors will likely recommend certain steps to prevent infection, including getting all recommended vaccinations.
People with myeloma may have a weaker response to vaccines because their immune systems are dysfunctional, but standard inactivated vaccines are usually safe and recommended. Vaccines for myeloma patients may include ones to prevent:
- COVID-19
- influenza
- pneumonia
- shingles
- hepatitis A and B
- tetanus, diphtheria, and pertussis
Vaccines that use live but weakened germs are generally not safe for people who are immunocompromised. The timing of vaccinations relative to cancer treatment also matters. A doctor will tell each patient which vaccines they should receive and when to schedule them.
Depending on a person’s treatment regimen, doctors may also suggest that patients receive other preventive medications (prophylaxis) for added protection. This could include:
- antiviral, antibiotic, or antifungal medications
- intravenous immunoglobulin, which contains healthy antibodies from donor blood
- granulocyte-colony stimulating factor, a treatment that helps the bone marrow produce more immune cells
Lifestyle changes are also part of infection prevention. These could include:
- washing hands frequently
- wearing masks
- avoiding crowded spaces and sick individuals
- avoiding foods that could cause illness, such as raw fish or vegetables, depending on the situation
What to do when there are signs of infection
People with myeloma should always tell their healthcare providers if they think they might have an infection. Even if the symptoms seem mild, they can progress quickly and become very serious. Certain treatments may also need to be delayed if a person is feeling unwell.
Symptoms to report include:
- fever
- chills, shivering, or sweating
- cough
- sore throat
- nose or ear congestion
- shortness of breath
- burning with urination
- uncontrollable diarrhea or abdominal pain
- redness, swelling, or draining from a wound
- rash
Certain infection symptoms could signal a medical emergency. If these occur, individuals should seek immediate care. These include:
- a high fever
- fever with chills or trouble breathing
- chest pain
- confusion
- uncontrolled vomiting
- extreme pain
Fevers in people with myeloma and other types of cancer must be taken much more seriously than they would be in a healthy person. A doctor will tell each patient exactly when to go to the emergency room for a fever in myeloma, but it is often when the temperature reaches 100.4°F or higher.
Questions to ask about staying safe during treatment
After their myeloma diagnosis, patients can ask their oncologist a few questions to ensure that infection risk in myeloma is properly managed. These include:
- How likely is my specific treatment regimen to impact my myeloma infection risk?
- What vaccines should I receive, and when should they be given relative to treatment or stem cell transplant?
- Do I need to take preventive medications to avoid infections?
- How will my immune function be monitored during treatment?
- How do I know when a symptom or a fever means I should call you or go directly to the emergency room?
- What precautions do I need to take in everyday life to avoid infection, such as masking or social distancing? Can I still spend time with my loved ones?
- Are there certain high-risk foods I should avoid during treatment?
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
