Managing infection risk while living with RRMM
Fact-checked by Managing infection risk with relapsed and refractory multiple myeloma (RRMS) is of the utmost importance because this cancer and its treatments can weaken your immune system, meaning you’re more vulnerable to infections.
When you’re immunocompromised, you’re more likely to experience:
- an inability to fight off infections
- more severe symptoms
- extended duration of illness and longer recovery times
- complications from infections, such as pneumonia
- a reactivation of viral infections you’ve had in the past, such as varicella-zoster virus (shingles or chickenpox) or Epstein-Barr virus (the cause of mononucleosis)
For people with RRMM, these infections can have serious consequences. In a population-based study in Sweden, researchers found a threefold risk of dying from an infection in individuals with multiple myeloma compared with people without the condition.
While the risk of infection in RRMM can be concerning, you can take steps to protect yourself by focusing on healthy habits, careful food preparation, and getting recommended vaccinations.
Why RRMM makes you more vulnerable to infections
Multiple myeloma is a cancer that affects plasma cells, which are a type of white blood cell found in your bone marrow that normally produce antibodies to fight infections. In myeloma, these cells become cancerous and do not function properly, meaning your body can’t produce the antibodies needed to fight off harmful invaders.
The cancer cells also force out any remaining healthy white blood cells, which are essential to a healthy immune system. This leaves you at a higher risk of infection.
When multiple myeloma has relapsed or become refractory — meaning it’s returned after an initial response or has failed to respond to treatment — the risk of infections can be even higher. That’s because the cumulative use of therapies to treat the cancer takes a toll on your immune system. A 2025 review article on multiple studies and clinical trials found that certain RRMM therapies can increase infection risk by more than 50%.
Simple everyday habits to keep germs at bay
Frequently washing your hands, avoiding people who are sick, and carrying hand sanitizer are all helpful habits for avoiding infections when you have myeloma. But with this condition, it’s best to take a few extra precautions because your immune system is compromised.
Here are some things you can try to prevent germs:
- Replace shared fabric hand towels in high-traffic bathrooms with single-use disposable paper towels to prevent bacteria that grow on damp or wet surfaces.
- Regularly sanitize frequently touched items, such as home medical equipment, personal blood pressure cuffs, pulse oximeters, thermometers, and the specific spaces around home infusion ports.
- Follow proper handwashing guidelines tailored for oncology patients. Use lukewarm water instead of hot water to prevent painful skin cracking, and immediately follow up with a nonscented barrier cream to prevent potential skin problems and irritations.
- Identify areas of the house that tend to be the most germy, especially in the kitchen and bathroom. In the kitchen, you’re most likely to encounter germs because of raw meats that can carry bacteria or parasites. In the bathroom, germs can linger in and around the toilet bowl.
You can also wear a KN95 or N95 face mask, especially in large crowds, and up your oral hygiene game. Take extra care around household pets, particularly dogs or cats who can track in outdoor germs.
Food safety tips for a compromised immune system
In addition to keeping a clean house, mouth, and hands, you’ll also need to keep your food as clean and safe as possible. Food-borne illnesses such as Escherichia coli, commonly known as E. coli, and salmonella can usually be avoided by following these steps:
- Scrub thick-skinned produce with a dedicated brush, avoid high-risk items like raw sprouts, and ensure all berries or leafy greens are washed under a stream of running water or soaked in a bowl.
- Organize your kitchen with color-coded cutting boards used specifically for raw meat, poultry, and seafood. Use a dedicated digital food thermometer to check that all meats are cooked to safe internal temperatures.
- Replace open water pitcher filters or well water with reverse-osmosis filtration systems or sealed, single-use bottled water to minimize microbial exposure. Reverse-osmosis filtration systems can remove harmful germs such as parasites and bacteria that grow in water; pitcher filters are primarily designed to improve taste and smell. It’s important to check filter specifications to see what they’re capable of removing before purchasing.
Vaccines and preventive therapies
While it’s recommended that everyone get their vaccinations as needed, it’s especially important for people living with RRMM to do so.
Coordinate any vaccines, such as a flu shot, around therapy cycles to ensure shots are administered during optimal immune recovery windows rather than periods when your white blood cell count drops. Otherwise, the vaccinations may not be as effective because your immune system is not capable of generating memory to recognize and fight the same kind of infection in the future.
A personalized approach to vaccination while undergoing treatment for multiple myeloma is important for optimizing vaccine effectiveness. This includes considering your current treatment phase, immune status, and how well your disease is controlled.
To decrease your risk of infection, which can lead to severe symptoms or complications, your doctor may prescribe preventive regimens such as antiviral medications or antibiotics. Your care team may alsorecommend adding specialized intravenous immunoglobulin (IVIG) infusions to your treatment plan. Immunoglobulin consists of immune system antibodies collected from donors to help boost your antibody counts and ultimately help prevent infections.
When to immediately contact your care team
The International Myeloma Foundation and the American Cancer Society recommend contacting your oncologist or visiting your local emergency department when you start to see signs of infection, especially a temperature of 100.4 F (38 C) or higher.
Other signs of infection may include:
- localized warmth or swelling near an infusion site
- chills or sweats
- chest congestion
- a persistent, dry cough
- new or worsening confusion
To fast-track your call to the right person at your oncologist’s office or emergency department, you can use this script:
I am a relapsed/refractory multiple myeloma patient currently receiving treatment. My temperature has reached X degrees, and I’m also experiencing [symptoms]. I’m concerned this could be an infection. Please connect me with the hematology-oncology team urgently and tell me whether I should go to the emergency department.
By taking a few extra precautions in your day to day life and implementing long-term preventive strategies, you can protect your immune system with RRMM. And if you do come down with a bug, your care team will figure out the best course of action to manage it.
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.
