Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0–2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.
感染仍然是多发性骨髓瘤（MM）患者常见的并发症，并与发病率和死亡率相关。预测早期严重感染发生风险的风险评分有助于识别可能从预防措施中获益的患者。我们对西班牙骨髓瘤组的四项临床试验中的感染情况进行了事后分析，共纳入1347例患者（其中847例为移植候选者）。关于GEM2010>65试验，由于强制要求抗生素预防性治疗，我们将其排除在最终分析之外。前6个月内严重感染事件的发生率为13.8%，且多数患者的首次感染事件发生在4个月内（11.1%）。有1.2%的患者在前6个月内因感染死亡（其中1%发生在4个月内）。与4个月内严重感染风险增加相关的变量包括血清白蛋白≤30 g/L、ECOG评分>1、男性以及非IgA型多发性骨髓瘤。基于这些变量构建的简易风险评分可将患者划分为三个风险组，其在4个月内发生严重感染的概率分别为：低危组（评分0-2）8.2%；中危组（评分3）19.2%；高危组（评分4）28.3%。中高危组患者可考虑作为预防性抗生素治疗的适用对象。
A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma
肿瘤(癌症)患者之家