Infection and myeloma

Myeloma affects the cells that support your immune system, so your body cannot fight infections as well as usual. Treatments for myeloma can also weaken your immune system, even when they are working. This means you are more likely to get infections, so it is important to help prevent them and treat them quickly.

What is the role of your immune system?

Your immune system is your body’s defence against infection and disease. 

Bacteria, viruses, and fungi that cause infection are called pathogens (germs). Your immune system’s job is to detect and destroy these pathogens to stop you from becoming very unwell.

Why does myeloma increase your risk of infection?

Myeloma cells multiply and spread in the bone marrow, crowding out the normal red blood cells, white blood cells and platelets.

When your bone marrow produces fewer healthy white blood cells, your risk of getting an infection increases, and it’s harder for your body to fight infection.

Myeloma treatments can also weaken your immune system by reducing the number of immune cells or changing the way your immune system works.

You might hear your treating team talk about neutrophils. These are a type of white blood cell that help your body fight infection. When your neutrophil level is low, it’s called neutropenia. This means your body may have more difficulty fighting bacteria and viruses, so you have a higher risk of getting an infection. Neutropenia can be caused by myeloma itself or by myeloma treatments.

When your myeloma is treated and under control, your body can start making healthy white blood cells again. Your immune system begins to recover and fight infection better.

Recovery can take time, and is different for each person. That’s why it is important to continue to take steps to help prevent infection. Your haematologist will help you do this by monitoring your immune system with regular blood tests.

Preventing infection

Things you can do to help prevent infection

• Wash your hands regularly with soap and water, or use an alcohol-based hand sanitiser.  
• Avoid crowded places where infections can spread easily when your immune system is low. This includes large public events, supermarkets and public transport.
• Wear a mask if you can’t avoid crowds, if someone in your household is sick, when  gardening, or in dusty environments. 
• Wear protective gloves when gardening and cleaning to protect your hands from cuts, insect bites or bacteria in the soil. 
• Use protective equipment such as a mask and gloves when building, renovating or cleaning dusty or mouldy areas.  
• Keep your mouth clean by brushing your teeth, using alcohol-free mouthwash and having regular check-ups with your dentist. 
• Stay away from family, friends and colleagues who have recently been sick. Wait until they are feeling better and symptom-free before getting together again. 
• When handling pets and animals, use disposable gloves for waste, wash your hands after removing the gloves or touching animals, and get any scratches or bites checked by a doctor. 
• Use good food hygiene by washing your hands before eating, avoiding high-risk foods, and by storing and preparing food safely. 

At first I didn’t want to make a fuss, but now I know how important it is to avoid infections. I let all my visitors know to stay away if they’re sick, and I keep some hand sanitiser at the door so people can use it on their way in.

–Shari, Western Australia

Healthy habits to support your immune system

• Nutrition: Eating a balanced diet with a wide range of fresh, unprocessed foods fuels your body and can help fight infection. 
• Sleep: Good sleep helps support your immune system. Helpful immune cells and chemicals that fight infection are released during sleep. 
• Exercise: Regular exercise can strengthen your immune system. 

Preventative medicines

To support your body and help prevent infection, your treating team may prescribe some preventative medicines to take alongside your myeloma treatments.

Here are some of the types of medicines you may be prescribed and common examples.

Type of medicine	Examples
Antivirals	Valaciclovir (also called by the brand name Valtrex®)  Aciclovir
Antifungals	Fluconazole  Trimethoprim/sulfamethoxazole (also called by the brand name Bactrim®)
Antibacterials	Preventative antibacterial medicines are not prescribed as often, but may be recommended depending on your personal risk factors.

During my stem cell transplant my immune system was very low. I needed to take some medicines to help prevent infections while I was in hospital, and for a few months afterwards while my immune system was recovering.

–Sofia, New South Wales

Vaccinations

Vaccinations teach your immune system to recognise bacteria and viruses – and remember how to fight them. When your body is exposed to the bacteria or virus you have been vaccinated against, your immune system is already trained to recognise and attack the bacteria or virus. This helps prevent serious infection.

There are two types of vaccines: live vaccines and non-live vaccines (also called inactivated vaccines):

• Live vaccines are generally not recommended for people with myeloma because they could make you unwell when your immune system is weakened. These vaccines use a weakened form of a virus or bacteria that can still grow and make copies of itself, but cannot cause infection or illness in a healthy immune system.  
• Non-live (inactivated) vaccines are safe for people with myeloma, even when your immune system is weakened. They introduce only parts of a virus or bacteria that cannot grow or make copies of itself, and therefore cannot cause infection or illness.  

Some of the common inactivated vaccines that your treating team may recommend for you include:

• influenza (flu)  
• COVID-19  
• pneumococcal disease 
• shingles   
• respiratory syncytial virus (RSV)  
• meningococcal disease. 

Immunoglobulin therapy

Immunoglobulin therapy is a type of supportive care treatment that helps increase the number of immunoglobulins (antibodies) in your body to help prevent infection. 

You may receive this therapy if your immunoglobulin levels are very low, which is called hypogammaglobulinemia. This supportive care treatment can be given as a drip into your vein, or as an injection under your skin. 

Recognising early signs of infection

If you have signs of infection, get medical help at your nearest emergency department as quickly as possible to avoid becoming very unwell.  

Common signs of an infection include: 

• a temperature of 38°C or above  
• chills and/or sweats  
• cough, sore throat, or runny nose  
• shortness of breath  
• burning or pain when you urinate (wee) 
• diarrhoea or vomiting 
• a red, swollen, or inflamed area 
• neck stiffness  
• rash.

If you go to the emergency department, make sure you let them know: 

• you have myeloma 
• if you are on any treatment or when you last had treatment  
• the name of your treating hospital  
• if you have an emergency alert card from your treating hospital  
• the symptoms you have. 

Make sure you have a reliable thermometer at home. You want to be sure to catch a fever as early as possible.

–Trish, Queensland 

Testing for infection

When you have symptoms of an infection, your treating team or the emergency department will do some tests to find the cause, so they can give you the most effective treatment.    

These tests may include: 

• blood tests (called blood cultures) 
• an x-ray of your chest 
• samples of your urine (wee), poo or saliva  
• swabs of your nose and throat, or sores and wounds. 

The results of some of these tests can take a few days to come back, so you may be started on broad-spectrum antibiotics while waiting for the results. This treatment covers a range of different infections until your treating team knows which pathogen is causing your infection.

Treating infections

Your treatment will depend on the type of infection you have and how unwell you are. Some infections can be treated with oral medicines including tablets and liquids, or topical creams that you apply to the infected area.

If you are very unwell, have a more serious infection, or you are neutropenic (have low neutrophils), you may need to stay in hospital to have treatment through a drip into your vein and be closely monitored.

Type of infection	Treatment	How it’s given
Bacterial	Antibiotics	Oral tablets or liquids  Drip into your vein
Viral	Antivirals	Oral tablets  Drip into your vein
Fungal	Antifungals	Oral tablets or liquids  Drip into your vein  Topical creams to the affected area

Supportive care treatments

As well as treating your infection, you may need some supportive treatments to help your body while it fights the infection. 

These may include: 

• paracetamol to help bring your temperature down when you have a fever 
• fluids through a drip into your vein to support your blood pressure and keep you hydrated 
• filgrastim (also called G-CSF) – an injection under your skin that helps your body make more neutrophils (a type of white blood cell that helps fight infection).