Invasive Pulmonary Aspergillosis in Multiple Myeloma patients: A sizeable diagnosis in the era of novel anti-myeloma therapies

Background Advances in treatment for multiple myeloma (MM) patients entail a high risk for opportunistic infections such as invasive pulmonary aspergillosis (IPA). Objectives This study was conducted to describe the patient's profile, clinical manifestations, diagnosis and outcome of MM patients with IPA, in our large haemato-oncology centre. Patients/Methods We retrospectively analysed patients with MM who underwent Broncho alveolar lavage for pneumonia at Rambam Hospital during a 13-year period from July 2005 to February 2018. We focused on those with Aspergillus pneumonia. Results Of the 669 patients with multiple myeloma, mean age 62.6 (+/- 7.6) years, forty-two patients (6.2%) were diagnosed with IPA. Among them, 60% had a probable diagnosis and 40% possible. Clinical presentation was similar for IPA and other pulmonary infections. Compared to those with other pulmonary infections, IPA was more commonly diagnosed in patients with long-standing disease (p = .00012) and among patients receiving 3 or more lines of myeloma therapies (p = .04). Thirty-day mortality rates following diagnostic bronchoscopy did not differ between IPA and non-IPA patients. (p = .85). Conclusions Multiple myeloma patients had an increased risk for IPA, most notably in patients with 3 or more lines of anti-myeloma treatment and more advanced disease. This clearly emphasises the vigilance needed for IPA in these patients.

Automated summary

This study retrospectively analyzed 669 patients with MM at Rambam Hospital, among whom 42 (6.2%) were diagnosed with IPA. Compared to other pulmonary infections, IPA was more commonly diagnosed in patients with long-standing disease and those receiving 3 or more lines of myeloma therapies. There was no difference in 30-day mortality rates following diagnostic bronchoscopy between IPA and non-IPA patients.