Multiple myeloma - Private Practice Infectious Disease

Review this module to better understand infectious complications in patients with multiple myeloma and associated therapy.

49 yo woman with PMH relapsed refractory IgG Lamba Multiple Myeloma, most recently treated with Isatuximab, Pomalyst, dexamethasone presents to the hospital with 3 days of altered mental status, fevers, generalized malaise and CXR shows a dense left lower lobe consolidation. Based off her underlying disease, prior treatments and clinical presentation, what is the most likely diagnosis?

A. Viral infection with HSV pneumonia

B. Bacterial infection/pneumonia with an encapsulated organism

C. Reactivation pulmonary TB

D. Aspergillus pneumonia

None

What strategy would you use to reduce the risk of this type of infection in this patient?

A. Vaccinate with both the conjugated and polysaccharide pneumococcal vaccine (at least 8 weeks apart)

B. Monitor IgG levels and replete when IgG < 400

C. Antibiotic prophylaxis when neutropenic

D. All of the above

None

With Bortezomib, what type of infection is 4X more likely compared to treatment with high dose dexamethasone?

A. Haemophilus influenza

B. Varicella Zoster infection

C. Aspergillus CNS infections

D. Pneumocystis jirovicii pneumonia

None

One year post BCMA CAR-T cell therapy for relapsed multiple myeloma, what percentage of patients have persistent hypogammaglobulinemia?

A. <5%

B. Nearly 100%

C. ~75%

D. 25%

None

During the early pre-engraftment period post autologous SCT for multiple myeloma, of the following options, which infection is the most likely?

A. CMV viremia

B. Bacterial infections/complications related to mucositis

C. Pneumocystis pneumonia

D. Aspergillosis pneumonia

None

Board Review: Multiple myeloma

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