RSV May Complicate Multiple Myeloma Care Through Therapy Delays, Not Mortality Risk

Respiratory syncytial virus (RSV) was not associated with increased mortality in patients with multiple myeloma (MM), but it may delay anti-myeloma therapies. The data were presented at IDWeek 2025, which took place October 19 through October 22, 2025, in Atlanta, Georgia.¹

Can RSV Complicate MM Care?

The treatment landscape for MM has changed dramatically over the past few decades. Immunotherapy and cellular therapies are the cornerstone of treatment for patients with MM. Despite their widespread and continued success, these therapies carry an increased risk of infection stemming from the immunodeficiency associated with both the disease and its treatments.²

There is little data around the incidence and impact of RSV in in MM, leading a team of researchers to assess electronic health records of patients with MM and cases of RSV to elucidate the potential relation. They identified 72 episodes of RSV infection in 69 patients with MM from January 2015 to January 2024. The population assessed was 64% male with a median age of 68 years (range 40-84). Twenty-six patients underwent autologous stem cell transplant with a median number of 2 lines of prior therapy (range 0-12).¹

Which RSV-Related Factors May Impact MM Treatment?

According to the health records, patients presented with cough (92%), dyspnea (47%), wheezing (36%), and fever (32%). Thirty-seven patients had lower respiratory tract infection (LRTI), and 32 (44%) patients were hospitalized at the time of or soon after RSV diagnosis.¹

Among the identified cases, antibiotics were administered to approximately half of the patients, while 7 received ribavirin (Rebetol; Merck & Co) therapy. Chemotherapy was postponed in 37 patients (51.4%). Two patients died within 30 days of infection, though RSV was not determined to be the cause of death in either instance.¹

Analysis revealed that both absolute neutrophil count (ANC) and corticosteroid exposure within the preceding 30 days were linked to the development of LRTI.¹

When both variables were included in a multivariable model, a higher ANC remained significantly correlated with lower respiratory tract infection (LRTI; OR, 1.269; 95% CI, 1.019–1.580; P = .033). A possible association between higher steroid dose and greater LRTI risk was also observed (OR, 1.036; 95% CI, 0.999–1.074; P = .055), although the limited sample size warrants cautious interpretation of these results.¹

“Overall, we found that MM patients commonly had LRTI but did not have attributable mortality from RSV, though infection resulted in a delay in anti-myeloma therapy most of the time,” the authors wrote. “Future trials should assess the impact of RSV vaccines and/or treatments on oncologic outcomes in addition to RSV-related morbidity.”¹

REFERENCES

1. Fuller R, Wright I, Jacobs SE, et al. (P-687) Respiratory syncytial virus infection in patients with multiple myeloma. Presented at: IDWeek 2025. October 19-22, 2025. Atlanta, Georgia. Abstract P-687.

2. Blimark C, Carlson K, Day C, et al. Risk of infections in multiple myeloma. A populationbased study on 8,672 multiple myeloma patients diagnosed 2008-2021 from the Swedish Myeloma Registry. Haematologica. July 18, 2024. doi:10.3324/haematol.2024.285645