Introduction

Myeloma is primarily a disease of older age groups with the median age of diagnosis above 60 years. Although, in the past, the prognosis was poor, this has changed over the past decade with the advent of new therapies and the use of autologous stem cell transplantation. Whereas formerly the infective problems associated with myeloma were the consequence of the disease itself and were often the mode of presentation, now the disease can be viewed as more chronic and infections are more commonly related to either the therapies used or the longer term complications of myeloma itself. Nevertheless, infections still account for the majority of deaths in the first 120 days after diagnosis. This chapter will address the risk factors for infection in myeloma and will outline the more common infective complications and their management, as well as considering what preventive measures can be taken.

Risk factors for infection

Immunodeficiency

The hallmark of myeloma is B cell dysregulation, usually manifested by hypogammaglobulinemia. This leads to an increased risk of bacterial infections, particularly those due to encapsulated organisms such as Streptococcus pneumoniae and Haemophilus influenzae. Other common bacterial infections that may present early on are Staphylococcus aureus and Eschericia coli[1]. However, there is ample evidence that the disease also affects cellular immunity with abnormalities of T lymphocytes, dendritic cells and NK cells. Although the cellular defects may be more subtle and do not normally manifest early in myeloma, they undoubtedly contribute to some of the complications of chemotherapy[2].