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Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients

Leukemia volume 36, pages 613–624 (2022)Cite this article

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Abstract

The role of infection and chronic inflammation in plasma cell disorders (PCD) has been well-described. Despite not being a diagnostic criterion, infection is a common complication of most PCD and represents a significant cause of morbidity and mortality in this population. As immune-based therapeutic agents are being increasingly used in multiple myeloma, it is important to recognize their impact on the epidemiology of infections and to identify preventive measures to improve outcomes. This review outlines the multiple factors attributed to the high infectious risk in PCD (e.g. the underlying disease status, patient age and comorbidities, and myeloma-directed treatment), with the aim of highlighting future prophylactic and preventive strategies that could be implemented in the clinic. Beyond this, infection and pathogens as an entity are believed to also influence disease biology from initiation to response to treatment and progression through a complex interplay involving pathogen exposure, chronic inflammation, and immune response. This review will outline both the direct and indirect role played by oncogenic pathogens in PCD, highlight the requirement for large-scale studies to decipher the precise implication of the microbiome and direct pathogens in the natural history of myeloma and its precursor disease states, and understand how, in turn, pathogens shape plasma cell biology.

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Fig. 1: Impact of pathogens on the hallmarks of plasma cell disorders.
Fig. 2: Risk factors of infection in plasma cell disorders.
Fig. 3: Impact of disease stage and treatment regimen on infection in clinical trials.
Fig. 4: Possible algorithm for antimicrobial prophylaxis and/vaccinations.

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Authors and Affiliations

  1. Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA

    Jessica Caro, Marc Braunstein, Louis Williams, Benedetto Bruno, David Kaminetzky, Ariel Siegel, Beatrice Razzo, Gareth J. Morgan, Faith E. Davies & Eileen M. Boyle

  2. Service de RĂ©animation et Maladies Infectieuses, CH Gustave Dron, Tourcoing, France

    Serge Alfandari

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  1. Jessica Caro
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  2. Marc Braunstein
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Contributions

EMB: designed the project. JC and EMB: reviewed the literature, wrote the manuscript. MB, LW, BB, DK, AS, BR, SA, GJM, FED: provided feedback, approved the manuscript.

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Correspondence to Eileen M. Boyle.

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Competing interests

Jessica Caro: None. Marc Braunstein: Research Support – Janssen, Celgene; Advisory: ADC Therapeutics, Amgen, AstraZeneca, Celgene, Epizyme, Janssen, Karyopharm, Morphosys, Pfizer, Takeda, TG Therapeutics, Verastem; Faculty Bureau: Janssen. Louis Williams: None. Benedetto Bruno: None. David Kaminetzky: None. Ariel Siegel: None. Beatrice Razzo: None. Serge Alfandari: None. Gareth J Morgan: Janssen – research funding; Bristol-Myers Squibb – consultancy, honoraria; Takeda – consultancy, honoraria; Celgene Corporation – consultancy, honoraria, research funding; Roche – consultancy, honoraria; Amgen – consultancy, honoraria; GSK – consultancy, honoraria; Karyopharm – consultancy, honoraria. Faith E Davies: Adaptive – honoraria; Celgene Corporation – consultancy, honoraria, research funding; Janssen – consultancy, honoraria; Oncopeptide - consultancy, honoraria; Roche – consultancy, honoraria; Sanofi - consultancy, honoraria; Takeda – consultancy, honoraria. Eileen M Boyle: None.

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Caro, J., Braunstein, M., Williams, L. et al. Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients. Leukemia 36, 613–624 (2022). https://doi.org/10.1038/s41375-021-01506-9

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