Global Epidemiology of Fungal Infections in Patients With Multiple Myeloma: A Systematic Review

Abstract Purpose of Review The purpose of this review was to evaluate the global epidemiology of fungal infections in patients with multiple myeloma (MM). Recent Findings Invasive fungal infections (IFIs) represent a significant cause of morbidity and mortality in patients with MM; in these patients, IFIs are mainly caused by species of the genera Aspergillus and Candida ; however, in recent decades, an increase in infections caused by other opportunistic fungi has been reported. Summary Among the fungal pathogens reported in MM patients, the most frequent were Aspergillus spp. 37.7% (n = 311), Pneumocystis jirovecii 19.2% (n = 158), Candida spp. 7.6% (n = 63), Aspergillus fumigatus 3.6% (n = 30), in addition to isolated cases of Fusarium spp., Trichosporon spp., and Histoplasma capsulatum. The diagnostic methods used were diverse, with conventional cultures and galactomannan assays predominating, while molecular and histopathological techniques were less frequently reported. Treatment included azoles, polyenes, and echinocandins in varying combinations according to the agent and clinical context. Only a fraction of the studies described clinical outcomes, with mortality rates ranging from 20% to 100%. The geographic distribution showed a higher concentration of cases in Sweden (49.7%), Korea (18.9%), and the United States (11.6%), reflecting contrasts in epidemiological surveillance and diagnostic capacity. This review highlights the need to strengthen the diagnosis and reporting of IFIs in patients with MM to improve the epidemiological characterization and clinical management of these infections in this vulnerable population.