Serological Screening in Multiple Myeloma: Uncovering Immunization Gaps and Latent Infection Risk in the Era of Immunotherapies
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Patients with multiple myeloma (MM) are at increased risk of infection across all phases of the disease, from diagnosis to relapse, particularly in the era of novel therapies. Mapping prior infectious exposure is a fundamental step in planning prophylaxis, immunization, and event monitoring. Brazilian data describing the serological profile of this population remain scarce; however, mandatory screening in patients undergoing autologous hematopoietic cell transplantation (HCT) may provide a representative picture of this epidemiology. Aim To characterize the serological profile of exposure to hepatotropic viruses, cytomegalovirus (CMV), HIV, and other infectious agents through serological screening in a cohort of MM patients undergoing HCT, with the aim of mapping infection/reactivation risk throughout the disease course. Methods This was an observational, retrospective, single-center study including patients with MM who underwent HCT between 2023 and 2025. Serology results for CMV, hepatitis B and C, HIV, syphilis, Chagas disease, and HTLV obtained during pre-HCT screening were analyzed. The serological profile was correlated with demographic and clinical variables (including prior anti-CD38 use). Results During the study period, 123 patients underwent HCT; 50.4% were female, with a median age of 60 years (range, 26–75), and 45% had received anti-CD38-based regimens. Pre-HCT serology results were available for 91.1% of the total sample (n=112). Among these, 88.4% were CMV IgG-positive and 6.3% were CMV IgM-positive. For hepatitis B, 2.7% were positive for both anti-HBc and anti-HBs (consistent with resolved infection), none of whom had a positive HBV-NAT; 20.5% had isolated Anti-HBs positivity, suggestive of vaccine-induced immunity. Anti-HCV was positive in 1.8% of patients, with no positive HCV-NAT results. No positive cases were identified for HIV, syphilis, HTLV, or Chagas disease. Age differed significantly according to CMV IgG serostatus (p = 0.048), being higher among CMV IgG-positive patients (61 years; range, 26–75) than among CMV IgG-negative patients (56.5 years; range, 45–69), indicating higher CMV seroprevalence among older patients. No significant association was found between Anti-HBs positivity and age (p = 0.764), indicating that vaccination coverage was low regardless of age or the incorporation of hepatitis B vaccination into the national immunization program. Conclusion We observed low adherence to/seroconversion following hepatitis B vaccination protocols during the early phase of treatment, indicating a gap in the immunization strategy for patients with MM. Furthermore, we identified latent viral infections with potential for reactivation during post-HCT immunotherapeutic treatment, including a high frequency of CMV seropositivity and, at lower frequencies, seropositivity for hepatitis B and C viruses. These findings demonstrate the need to optimize infectious risk management across all phases of MM treatment, supporting individualized surveillance, prophylaxis, and infection prevention strategies.
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223147188