Can multiple myeloma cause elevated band neutrophils (bands) in a complete blood count (CBC) in older adults with a history of anemia, bone pain, or recurrent infections?

Can Multiple Myeloma Cause Elevated Band Neutrophils?

Multiple myeloma itself does not directly cause elevated band neutrophils (bandemia) on CBC, but bandemia in myeloma patients typically indicates a secondary bacterial infection, which is a major complication of the disease. 1

Understanding the Relationship

Why Myeloma Patients Develop Infections Leading to Bandemia

• Myeloma patients have a 7-fold higher risk of bacterial infections compared to age-matched healthy individuals, making infection the leading cause of death in 22% of myeloma patients at one year. 1

• The increased infection susceptibility results from myeloma-related immunodeficiency involving B-cell dysfunction, functional abnormalities of dendritic cells, T-cells, and NK cells, not from direct bone marrow infiltration causing bandemia. 1

• Functional hypogammaglobulinemia is characteristic of myeloma—total immunoglobulin may be elevated, but the antibody repertoire is restricted, leading to recurrent sinopulmonary infections. 1

Common Pathogens Causing Bandemia in Myeloma

• Streptococcus pneumoniae, Haemophilus influenzae, and Gram-negative bacilli are the most frequent bacterial causes of infection in myeloma patients. 1

• These infections trigger the bone marrow to release immature neutrophils (bands) into circulation, producing the bandemia seen on CBC. 1

What CBC Actually Shows in Myeloma

Direct Myeloma Effects on CBC

• Anemia is present in approximately 75% of patients at diagnosis—normochromic, normocytic with hemoglobin <10 g/dL or ≥2 g/dL below normal. 1, 2

• Neutropenia can occur from bone marrow infiltration by plasma cells or from treatment (16-66% depending on regimen), but this is neutropenia, not bandemia. 1

• Thrombocytopenia may be present but is less common than anemia. 1

When to Suspect Infection vs. Myeloma Progression

• Elevated bands with fever, leukocytosis, or neutrophilia strongly suggests acute bacterial infection requiring immediate broad-spectrum antibiotics. 1

• Pancytopenia without bandemia suggests bone marrow infiltration by myeloma or treatment-related myelosuppression. 1

• Anemia with normal or low white count is the typical CBC pattern of untreated myeloma itself. 2, 3

Clinical Pitfalls to Avoid

• Do not attribute bandemia to myeloma itself—always investigate for infection, as this is a medical emergency in immunocompromised myeloma patients. 1

• Neutropenia from treatment (especially lenalidomide, melphalan-based regimens) increases infection risk further, with 16-66% experiencing neutropenia depending on the specific regimen. 1

• Recurrent infections are a presenting symptom of myeloma in some patients, so new-onset bandemia in an older adult with unexplained anemia or bone pain should prompt evaluation for both infection AND underlying myeloma. 2, 4

Management Implications

• Antibiotic prophylaxis should be considered for the first three months of therapy with lenalidomide or pomalidomide, particularly in patients with aggressive disease, history of infections, or neutropenia. 1

• Vaccination against Streptococcus pneumoniae, Haemophilus influenzae, and influenza is recommended, though efficacy may be suboptimal due to impaired immune response. 1

• Broad-spectrum antibiotics are required for any febrile illness in myeloma patients, regardless of band count. 1