Researchers have determined the risk of infection for immunomodulatory drug–based therapy and proteasome inhibitor–based therapy with respect to treatment phase in patients with multiple myeloma, according to a meta-analysis published in the European Journal of Cancer.1

For the study, investigators analyzed data from 13,105 patients with multiple myeloma included in 30 randomized clinical trials. Studies were conducted between 1990 and 2015 and evaluated treatment with immunomodulatory agent–based and proteasome inhibitor–based therapy compared with conventional therapy.

Results showed that the rate of severe infection with the use of immunomodulatory drug-based therapy was 13.4%, 22.4%, 10.5%, and 16.6% for non-transplant–eligible patients, transplant-eligible patients, maintenance therapy, and treatment for relapsed/refractory multiple myeloma, respectively.

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Researchers also found that the rate of severe infection with proteasome inhibitor–based induction therapy was 19.7% in transplant-eligible patients.

Compared with conventional therapy, the use of immunomodulatory drug-based induction therapy was associated with a 24% reduced risk of severe infection for transplant patients (relative risk [RR], 0.76; P <.01). There was no significant difference between conventional therapy and proteasome inhibitor–based induction.

The study further revealed that bortezomib-based induction therapy (RR, 2.03; P <.01) and lenalidomide maintenance therapy (RR, 1.95; P =.03) were associated with approximately twice the risk of severe infection vs thalidomide.

“Thalidomide is associated with the lowest risk of severe infection when used for induction and maintenance therapy,” the authors conclude.


1. Teh BW, Harrison SJ, Worth LJ, Thursky KA, Slavin MA. Infection risk with immunomodulatory and proteasome inhibitor–based therapies across treatment phases for multiple myeloma: A systematic review and meta-analysis. Eur J Cancer. 2016;67:21-37.