Infection Events in Patients With Newly Diagnosed Multiple Myeloma With Anti-cd38 Monoclonal Antibody-based First Line Regimens: A Multicentric Italian Experience

Introduction : Multiple myeloma (MM) is a malignancy characterized by the clonal proliferation of plasma cells. MM accounts for 1% of all neoplastic diseases and is the second most common hematologic malignancy after lymphoma. Infection is a significant cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM) patients, responsible for about 45% of early deaths especially in elderly patients and within the first months of therapy. Available treatments for MM, such as anti-CD-38 monoclonal antibody (CD38 MAbs), proteasome inhibitors, immunomodulatory agents (lenalidomide, thalidomide and glucocorticoids), demonstrated an improvement in the outcome of NDMM patients, however, predispose to increasing risk of infection. Daratumumab (Dara), an anti-CD38 MAbs is an important new agent in the therapeutic armamentarium of MM. Dara is approved for NDMM or relapsed/refractory MM (RRMM). The use of Dara has improved patient outcomes but has changed the frequency and epidemiology of infections. We retrospectively reviewed data of 472 patients who received Dara-containing regimen for NDMM treated in 10 centers members of the European Myeloma Network Italy (EMN-I) between 2020 and 2023, to study the incidence of IE. Of 472 patients, 148 (31.3%) (148 patients) encountered experienced infectious complications during therapy. No differences were found among the 3 above mentioned groups of patient. In our experience, the introduction of dara in the induction phase did not increase the frequency, degree and duration of infections in the 3 cohorts. Even though the difference was not statistically significant, we observed an earlier onset of IE in the D-VTD group as compared to the others. Further studies are warranted to define further the incidence of infections in these categories of patients, and identify factors associated with a higher risk profile for infection. This will also help understanding the role of infectious prophylaxis in the clinical management of NDMM.