Multiple Myeloma: Managing Infectious Episodes and High Infection Risk During Therapy

Patients with multiple myeloma receiving active treatment face a significantly elevated risk of infection. This protocol addresses two overlapping situations: an active infectious episode arising during therapy, and patients who are at high risk of developing serious infection.

Clinical Scenario

Multiple myeloma with an infectious episode occurring during therapy, or with factors placing the patient at high risk of infection while on treatment. Both situations require specific, evidence-based management to prevent morbidity and avoid interruption of myeloma-directed therapy.

Treatment Approach (Partial Overview)

Active infectious episodes require prompt treatment. Beyond acute management, a structured prophylaxis strategy — encompassing antibacterial agents, antiviral coverage, and recommended vaccinations — is applied according to the specific myeloma regimen in use and the patient's individual risk profile.

Full protocol details, criteria, and sequencing available below →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/s41571-025-01041-x

Infectious episodes require immediate therapy with broad-spectrum antibiotics [I, A].

Therefore, levofloxacin-based prophylaxis for infections during the first 3 months of therapy is useful, especially in patients receiving lenalidomide or pomalidomide, or in those at high risk of infections (for example, previous serious infections or neutropenia) [I, A].

Acyclovir or valacyclovir are recommended for prophylaxis of herpes zoster virus infections in patients receiving proteasome inhibitor-based, anti-CD38 antibody-based and BCMA-targeted therapies [II, B].

Vaccinations against influenza, varicella zoster, SARS-CoV-2 and pneumococcal infections are recommended [II, A].

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