Immune parameters in multiple myeloma patients:: Influence of treatment and correlation with opportunistic infections
Immune parameters in multiple myeloma patients:: Influence of treatment and correlation with opportunistic infections
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DOI：
10.1080/10428190500472503
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发表时间：
2006-08-01
影响因子：
2.6
通讯作者：
Nowrousian, Mohammad R.
中科院分区：
文献类型：
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作者：
Schuett, Philipp;Brandhorst, Dieter;Nowrousian, Mohammad R.
本研究评估了骨髓瘤患者的细胞和体液免疫参数，重点是治疗效果和机会性感染的风险。本文分析了77例骨髓瘤患者480例外周血淋巴细胞亚群和血清非骨髓瘤免疫球蛋白(Ig)水平。未经治疗的骨髓瘤患者的CD4+/45RO+、CD19+、CD3+/HLA-DR+和自然杀伤(NK)细胞以及非骨髓瘤患者的IgA、Ig G和Ig M显著降低。常规剂量化疗后，患者外周血中的CD4+细胞显著减少，CD4+/CD45RO+和CD19+细胞进一步下降，尤其是复发患者。额外的沙利度胺治疗对这些参数没有显著影响。在大剂量化疗(HD-CTX)后，观察到长时间的免疫抑制。虽然CD8+、NK、CD19+和CD+/CD45RO+细胞分别在60、90、360和720天内恢复到正常水平，但在此之后，CD4+细胞数量仍在下降。观察到9例机会性感染，包括5例巨细胞病毒(CMV)病，1例卡氏肺孢子虫肺炎(PCP)，3例水痘带状疱疹病毒感染合并CMV病，PCP仅发生在HD-CTX后。机会性感染与严重降低的CD4+，以及CD4+/CD45RO+和CD19+计数相关。因此，骨髓瘤患者表现出细胞和体液免疫缺陷，在常规和HD-CTX治疗后增加，并构成机会性感染的重要易感因素。
The present study evaluated cellular and humoral immune parameters in myeloma patients, focusing on the effect of treatment and the risk of opportunistic infections. Peripheral blood lymphocyte subsets and serum levels of nonmyeloma immunoglobulins (Ig) were analysed in 480 blood samples from 77 myeloma patients. Untreated myeloma patients exhibited significantly reduced CD4+/45RO+, CD19+, CD3+/HLA-DR+, and natural killer (NK) cells, as well as nonmyeloma IgA, IgG and IgM. Conventional-dose chemotherapy resulted in significantly reduced CD4+ and even further decline of CD4+/CD45RO+ and CD19+ cells, most notably in relapsed patients. Additional thalidomide treatment had no significant effects on these parameters. Following high-dose chemotherapy (HD-CTX), prolonged immunosuppression was observed. Although CD8+, NK, CD19+ and CD+/CD45RO+ cells recovered to normal values within 60, 90, 360 and 720 days, respectively, CD4+ counts remained reduced even thereafter. Nine opportunistic infections were observed, including five cytomegalovirus (CMV) diseases, one Pneumocystis carinii pneumonia (PCP) and three varicella zoster virus infections with CMV diseases and PCP occurring exclusively after HD-CTX. Opportunistic infections were correlated with severely reduced CD4+, as well as CD4+/CD45RO+ and CD19+ counts. Thus, myeloma patients display cellular and humoral immunodeficiencies, which increase following conventional as well as HD-CTX, and constitute an important predisposing factor for opportunistic infections.