Infection prevention and myeloma

Because myeloma cells and treatments reduce your immune system’s ability to fight infections, you and your doctor will need to take extra steps to help prevent infections and support your immune system.

General measures to prevent infection

There are many simple, common-sense steps you can take to help prevent infections:

• Keep up good hand hygiene at all times with regular hand washing, or by using alcohol-based hand sanitiser, especially after using the toilet, and before preparing or eating food. 
• Avoid crowded areas and contact with friends, family members or work colleagues who are unwell with symptoms such as a cough, runny nose, sore throat, diarrhoea or rashes. If you’re in a situation where you can’t avoid crowds or you feel uncomfortable, you can wear a mask. 
• When gardening, wear gloves to reduce exposure to toxins in soil and a mask to reduce exposure to dust.
• Wear a mask when you’re in a dusty environment. Dust can carry bacteria and fungi that can cause infection. 
• Use disposable gloves to handle pet waste. If you are scratched by an animal, watch the area closely for signs of infection, such as redness or swelling.

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

Specific steps to help prevent infection

Preventative medicines

Some treatments for myeloma can increase the risk of serious infections. Your treating team will usually prescribe medicines to reduce this risk during treatment or after a stem cell transplant.

Common preventative medicines include:

• Antibiotics (eg. Bactrim)
• Antivirals (eg. Valciclovir)
• Antifungals (eg. Fluconazole)

If you are prescribed any of these medicines, it’s vital that you take them regularly, following your treating team’s instructions. 

If you experience any side effects, it’s important to talk to your doctor about these rather than stopping your medicine. Often, there are different medicines you can take to reduce side effects and keep protecting you from infections. 

You may need to take anti-infective medicines long-term, so it’s important to make sure you always have a current prescription. 

Vaccinations

Vaccination can be an effective way to protect you from certain types of serious infections. 

If you are offered a vaccine, it’s important to check if it is an ‘inactive’ or ‘live’ vaccine. During treatment for myeloma, all inactive vaccines are safe for you to have. However, live vaccines, such as the measles, mumps and rubella (MMR) vaccine are not safe, unless your doctor has specifically advised that you can have it. 

People with myeloma should have:

• The inactive influenza vaccination every year before winter begins. 
• The pneumococcal vaccination
• The large dose of chemotherapy that’s given as part of stem cell transplantation can reduce some of the protection of childhood vaccinations. Your transplant team will usually recommend being revaccinated against a range of infections about 6 months after your transplant
• COVID-19 vaccination and treatment recommendations for people with myeloma are constantly evolving. Please ask your doctor to recommend the most appropriate protection against COVID-19 for you at the moment

Immunoglobulin therapy

Immunoglobulin is part of the blood’s plasma which contains antibodies that help to fight infections. 

If you‘re experiencing recurrent infections and your doctor discovers you have low levels of immunoglobulin IgG, you may be able to access immunoglobulin therapy. 

When people make a blood donation, the immunoglobulin part of the blood is removed, tested and then bottled ready for transfusion to people who need immunoglobulin therapy. It can be given as an injection into the skin (subcutaneously) or into a vein through a drip (intravenously) to help your immune system respond to infections. 

Overseas travel

If you are planning to travel overseas, it’s important to be aware of extra steps you’ll need to take to protect your health. Make an appointment well ahead of your travel to chat with your doctor or a travel health clinic about:

• additional vaccinations that you may need to have, which may take up to 2 weeks to have their full effect, and will usually depend on your destination/s. Certain travel vaccines, such as yellow fever, are live vaccines, which you will need to avoid. A travel health clinic can recommend different preventative medicines or vaccines that can be used by people with myeloma 
• any additional preventative medicines that you need to take 
• how to prevent blood clots, especially on long flights
• any extra prescriptions you may need so you can pack enough medicines for your trip 
• providing you with a summary of your recent myeloma treatment, which can be helpful if you have an emergency 
• giving you a signed and dated letter that lists all medicines you are currently taking. Carry this letter in your hand luggage with your medicines and keep a copy on your smart phone, electronic tablet or laptop computer. 

Recognising early signs of infection

If you do develop an infection, it’s important to seek medical attention 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 on urination
• a red, swollen, or inflamed area 
• neck stiffness 
• rash.

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

–Trish, Queensland