Ask the Nurse: Infections and myeloma

Living with myeloma increases the risk of infection which can be a concern for both patients and their loved ones. However, there are effective ways to help prevent infection and recognise early signs and symptoms ensuring prompt treatment when necessary.

In this month’s blog, we answer some of the questions you ask our Myeloma Infoline team about infections and myeloma.

Why does having myeloma mean I’m more at risk of infection?  

The immune system is the body’s defence against infection and usually works to quickly kill and remove infection. Myeloma affects how well your immune system works, preventing it from responding to infection as quickly or effectively as it should.

During remission, when your myeloma is under control, your immune system usually recovers to some extent. When the immune system is functioning more effectively, you will be less likely to get infections.

Unfortunately, some anti-myeloma treatments can also affect the immune system and make infections more likely. Usually, this improves once the patient has finished taking the treatment. Patients on long term treatment may need to have dosages reduced.

How does myeloma affect my immune system? 

Plasma cells are a type of white blood cell, and part of the immune system. Healthy plasma cells are involved in producing useful antibodies, (also called immunoglobulins, or IGs for short), which help to fight infection.

Myeloma cells are abnormal plasma cells. As they multiply, they prevent production of normal healthy blood cells, including immune cells needed to fight infection.

These abnormal plasma cells do not produce the usual useful antibodies. Instead, they can produce large amounts of a single type of antibody, called paraprotein, which serves no useful function.

People who have a weakened immune system, including those with myeloma, are sometimes described as being ‘immunocompromised’.

Read more about the immune system in myeloma and infection in our Infection and myeloma Infosheet.

Why can my treatment for myeloma make infections more likely?

Some anti-myeloma treatments can affect your immune system and lower the levels of immune cells in your body. If you are given treatment known to cause this side effect, such as lenalidomide (Revlimid^®), your doctor will carefully monitor your blood cell counts. Your healthcare team can offer specific advice to about how to help prevent infections during your treatment.

What if I’ve been told I’m severely immunocompromised?

Patients who have active myeloma or are on treatment are more likely to be at higher risk of infection than patients who are in remission. Your healthcare team will be able to tell you how robust your immune system is by looking at your most recent blood test results.

Some treatments are particularly likely to impact your immune system, such as high-dose therapy and stem cell transplantation (HDT-SCT) but usually this is temporary. If you are told that you are severely immunocompromised, you will be advised to follow stricter guidelines to help prevent infection and stay well – your healthcare team can provide specific guidance to support you.

This can be challenging but your immune system can recover and get stronger again when the myeloma is under control and/or as your treatment changes.

What signs of infection can I look out for?

Knowing how to spot infections early helps you to let your healthcare team know immediately. Signs and symptoms to look out for include:

• Fever (temperature above 37.5°C)
• A temperature below 36°C
• Chills and sweating
• Change in cough or a new cough
• Sore mouth and throat
• Blocked nose and/or ears
• Burning sensation or pain when passing urine, or a frequent need to urinate
• Diarrhoea or pain in the abdomen
• Nausea or vomiting
• Redness or swelling in any area
• New onset of pain
• Rash
• Redness, heat or swelling around a Hickman®/PICC line  

Does my infection need treating?

A weakened immune system can make even a minor infection more likely to develop into something more serious. If you suspect you have picked up an infection, tell your doctor or nurse promptly so that they can assess your condition and provide treatment if needed.

Treatment will vary depending on the type of infection and can involve preventative treatments as well as treatments for existing infections. If you are given treatment for an infection, such as antibiotics, it is important to take the treatments as prescribed and complete the full course even if you start to feel better.

Are other people an infection risk?

Spending time in confined or crowded spaces, or in close proximity to others can increase your risk of infection if your immune system is weakened. However, there are practical steps you can take to balance avoiding infection with spending quality time with your friends and loved ones.

Avoid crowded public spaces or transport when possible but if the trip is essential, choose quieter times of the day and make sure to wash hands regularly to help reduce risk. Some patients choose to wear a face mask and bring some alcohol hand gel along with them.

Spending time with loved ones is important for wellbeing, but letting your friends and family know that you are at higher risk of infection can help them to understand the importance of delaying a visit when they have signs of infection.

After a family member or close contact receives certain vaccinations, it can be wise to limit contact or take precautions when spending time together for a few weeks. This isn’t necessary for all vaccines and complete avoidance isn’t always needed. Read more about which vaccines this applies to and preventative steps in our Vaccines and myeloma Infosheet. Your healthcare team can offer advice based on your own specific circumstances.

What else can I do to help prevent infection?

There are some simple everyday things you can do to help prevent infection. Making sure to regularly bathe or shower and regularly washing hands with soap and water can reduce the risk of you picking up an infection.

Regular household cleaning can also help to reduce the chance of infection for you, including disinfecting key surfaces like kitchen counters. Cooking food thoroughly is important to reduce the risk of picking up infection from food.

Sticking to a healthy balanced diet, taking regular exercise if you can and getting enough sleep can help to support your immune system, as well as following medical advice from your healthcare team.

Are some foods an infection risk?

Most myeloma patients can follow a normal healthy, balanced diet but it is sometimes recommended to avoid products described as probiotic because these contain live bacteria which can increase risk of infection, particularly at times when your immune system is especially low.

If your immune system is especially weakened due to myeloma or your treatment, such as following HDT-SCT, your healthcare team may advise you to follow a special diet which may involve avoiding specific other foods. Your healthcare team will be able to provide instruction about managing your diet.

How can vaccines help?

Vaccines are treatments which can help protect against specific infections by stimulating antibody production. This helps the body respond quickly if exposed to the real infection.

Vaccination against certain infections is recommended for people living with myeloma, although not all types of vaccines are suitable for myeloma patients.

To find out more about how vaccines work and which are recommended for myeloma patients our Vaccines and myeloma Infosheet may be helpful. To find out more about the seasonal flu vaccine, check our Ask the Nurse blog on the topic.

If you have received HDT-SCT, you may need revaccination for diseases you were vaccinated for as a child as the treatment can reduce previous immunity. Your healthcare team can guide you on which vaccines you need, the recommended schedule and how to arrange these.