VAD and risk of bacterial infection

Haematologica 2003;88:1022-1028. "Risk factors for the development of bacterial infections in multiple myeloma treated with two different vincristine-adriamycin-dexamethasone schedules"
10/08/2003 01:50:00 PM
By Jill Taylor

Patients with multiple myeloma with profound hypogammaglobulinaemia who are treated with the combination of vincristine, adriamycin, and dexamethasone (VAD) are at major risk of bacterial infection (BI) during the first 4 months of therapy, especially in a hospital setting. Both disease-related and treatment-related factors increase the susceptibility of multiple myeloma patients to BI. VAD is commonly used as induction treatment for multiple myeloma in both hospital and outpatient settings, however the 2 treatment modalities have not been previously compared for probability of infection. To evaluate infectious complications in multiple myeloma and to identify variables associated with the development of bacterial infections during treatment, Clara Cesana of Niguarda Ca' Granda Hospital in Milan, Italy, and colleagues studied 97 patients treated by 1 of 2 different schedules of combination chemotherapy. All study subjects received VAD administered by either continuous intravenous infusion (hospitalised patients) or by rapid intravenous infusion (outpatients). Additionally, patients were monitored for infections during the course of chemotherapy and for approximately 1 month of follow up. The researchers retrospectively analysed VAD schedules and clinical characteristics of patients to detect correlations with the incidence of BI. Overall, 33% of patients developed BIs, of which pneumonia accounted for 72% of major infections. In contrast to the community-acquired infections observed in outpatients, 44.4% of infections in hospitalised patients were nosocomial. BI incidence was significantly higher during cycles delivered within the first 4 months of treatment as compared to later cycles (1.3 versus 0.2 per person-years, p<0.0001). Furthermore, the continuous intravenous infusion schedule (p=0.07) and profound hypogammaglobulinaemia (p=0.1) were associated with a tendency to a higher risk of infection, and independently predicted BI probability (p<0.015 and p<0.03, respectively). Based on the results, the investigators recommend avoiding hospitalisation and consideration of antibacterial prophylaxis with intravenous immunoglobulins for patients who require admission.