How to Reduce Infection Risk in Multiple Myeloma Patients

Multiple myeloma significantly increases the risk of infections due to its profound impact on the immune system. This blood cancer originates in plasma cells—white blood cells responsible for producing antibodies that fight infection. In healthy individuals, plasma cells generate a diverse range of immunoglobulins (antibodies) to defend against various pathogens. However, in multiple myeloma, malignant plasma cells multiply uncontrollably and produce only a single, abnormal type of immunoglobulin, often referred to as monoclonal protein or M-protein.

Why Infections Are Common in Myeloma Patients

The overproduction of this dysfunctional antibody crowds out healthy plasma cells, leading to a condition called immune suppression or hypogammaglobulinemia, where the body produces insufficient levels of normal, protective antibodies. As a result, patients lose their ability to mount an effective immune response against bacteria, viruses, and fungi. This makes them highly vulnerable to recurrent and sometimes severe infections—even from organisms that are typically harmless in healthy people.

In addition, treatments like chemotherapy, corticosteroids, and stem cell transplants, while essential for controlling myeloma, can further weaken the immune system. Therefore, infection remains one of the leading causes of hospitalization and mortality among myeloma patients.

Strategies to Lower Infection Risk

1. Treat the Underlying Myeloma Aggressively

The most effective way to improve immunity is to target the root cause—the malignant plasma cell clone. By using modern therapies such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and, when appropriate, autologous stem cell transplantation, doctors aim to achieve deep remission. When the abnormal clone is suppressed, there's often partial recovery of normal immune function. As healthy plasma cells regain space and functionality, the production of protective antibodies gradually improves, reducing susceptibility to infections.

2. Use Preventive (Prophylactic) Medications

For patients at high risk of specific infections, prophylactic treatment can be life-saving. For example:

• Antifungal prophylaxis may be recommended for those undergoing intensive therapy or with prolonged neutropenia, especially in settings with high fungal exposure.
• Antibacterial prevention, such as low-dose penicillin or trimethoprim-sulfamethoxazole, is often used in patients with recurrent bacterial infections, particularly those involving encapsulated organisms like Streptococcus pneumoniae.
• Antiviral medications, including acyclovir or valacyclovir, are routinely prescribed to prevent reactivation of herpes viruses, especially during steroid-based treatments.

Your healthcare provider will tailor these preventive strategies based on your individual risk profile, treatment phase, and medical history.

3. Vaccinations and Immune Support

Although vaccine responses are generally weaker in myeloma patients, staying up-to-date on recommended vaccines is still crucial. Key vaccinations include:

• Influenza vaccine (annual)
• Pneumococcal vaccines (PCV20, PPSV23)
• COVID-19 vaccines and boosters
• Shingles vaccine (non-live, recombinant zoster vaccine)

Live vaccines should be avoided in immunocompromised individuals. Discuss timing with your oncologist, ideally before starting treatment or during periods of remission.

Lifestyle and Hygiene Tips for Added Protection

Beyond medical interventions, everyday habits play a vital role in minimizing infection risk:

• Practice frequent handwashing with soap and water.
• Avoid crowded places, especially during flu season.
• Maintain good oral hygiene—dental infections can quickly escalate.
• Cook food thoroughly and avoid raw or undercooked items.
• Stay hydrated, eat a balanced diet rich in nutrients, and get adequate rest to support overall health.

While it's impossible to eliminate all infection risks, a comprehensive approach combining effective myeloma treatment, targeted prevention, and healthy lifestyle choices can significantly enhance quality of life and improve outcomes for patients living with multiple myeloma.