Poor Correlation between Pneumococcal IgG and IgM Titers and Opsonophagocytic Activity in Vaccinated Patients with Multiple Myeloma and Waldenstrom's Macroglobulinemia
Poor Correlation between Pneumococcal IgG and IgM Titers and Opsonophagocytic Activity in Vaccinated Patients with Multiple Myeloma and Waldenstrom's Macroglobulinemia
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DOI：
10.1128/cvi.00654-15
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发表时间：
2016-04-01
影响因子：
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通讯作者：
Wenneras, Christine
中科院分区：
文献类型：
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作者：
Karlsson, Johanna;Roalfe, Lucy;Wenneras, Christine
患有多发性骨髓瘤和其他B细胞疾病的患者对肺炎球菌疫苗的反应很差。通常通过用酶联免疫吸附试验(EL ISA)、功能性吞噬细胞试验(OPA)或两种方法测定肺炎球菌血清型特异性抗体来确定疫苗的反应性。我们在接种疫苗的老年多发性骨髓瘤、Waldenstrom巨球蛋白血症和未确定意义的单克隆性丙种球蛋白病(MGUS)患者中比较了这两种方法。对45例患者(每组15例)和15例对照组的免疫后血清用多重OPA法检测肺炎链球菌血清4、6B、14和23F型，并与酶联免疫吸附试验(EL ISA)测定的抗体效价进行比较。在对照组中，肺炎链球菌OPA滴度与所有血清型的免疫球蛋白抗体滴度均显著相关(相关系数在0.51~0.85之间)，而在骨髓瘤组中，所调查的任何一种血清型之间均无显著相关性(r=-0.18~0.21)，在Waldenstrom‘s巨球蛋白血症组中(4种血清型中有2种为临界显著相关)。MGUS组与对照组相似，两种检测方法对4种血清型中的3种有很好的一致性(r=0.53~0.80)。与其他组相比，骨髓瘤患者接种肺炎球菌后的IgM滴度非常低，与OPA结果无关。综上所述，我们的数据表明，在患有B细胞恶性肿瘤的老年受试者中，ELISA检测可能高估了抗肺炎球菌的免疫力，功能性抗体检测应该专门用于骨髓瘤和Waldenstrom巨球蛋白血症患者。
Patients with multiple myeloma and other B cell disorders respond poorly to pneumococcal vaccination. Vaccine responsiveness is commonly determined by measuring pneumococcal serotype-specific antibodies by enzyme-linked immunosorbent assay (ELISA), by a functional opsonophagocytosis assay (OPA), or by both assays. We compared the two methods in vaccinated elderly patients with multiple myeloma, Waldenstrom's macroglobulinemia, and monoclonal gammopathy of undetermined significance (MGUS). Postvaccination sera from 45 patients (n = 15 from each patient group) and 15 control subjects were analyzed by multiplexed OPA for pneumococcal serotypes 4, 6B, 14, and 23F, and the results were compared to IgG and IgM antibody titers measured by ELISA. While there were significant correlations between pneumococcal OPA and IgG titers for all serotypes among the control subjects (correlation coefficients [r] between 0.51 and 0.85), no significant correlations were seen for any of the investigated serotypes in the myeloma group (r = -0.18 to 0.21) or in the group with Waldenstrom's macroglobulinemia (borderline significant correlations for 2 of 4 serotypes). The MGUS group resembled the control group by having good agreement between the two test methods for 3 of 4 serotypes (r = 0.53 to 0.80). Pneumococcal postvaccination IgM titers were very low in the myeloma patients compared to the other groups and did not correlate with the OPA results. To summarize, our data indicate that ELISA measurements may overestimate antipneumococcal immunity in elderly subjects with B cell malignancies and that a functional antibody test should be used specifically for myeloma and Waldenstrom's macroglobulinemia patients.