Effect of immunoglobulin therapy on the rate of infections in multiple myeloma patients undergoing autologous stem cell transplantation or treated with immunomodulatory agents.
Effect of immunoglobulin therapy on the rate of infections in multiple myeloma patients undergoing autologous stem cell transplantation or treated with immunomodulatory agents.
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DOI：
10.4084/mjhid.2010.005
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发表时间：
2010-04-20
影响因子：
3.2
通讯作者：
Brain T
中科院分区：
文献类型：
--
作者：
Khalafallah A;Maiwald M;Cox A;Burns D;Bates G;Hannan T;Seaton D;Fernandopulle B;Meagher D;Brain T
多发性骨髓瘤(MM)与免疫功能障碍引起的感染风险显著相关。感染是多发性骨髓瘤患者发病和死亡的主要原因。关于多发性骨髓瘤患者的感染率，特别是与新一代免疫调节药物(沙利度胺、硼替佐米、来那度胺)或自体干细胞移植(ASCT)后的感染相关的数据很少。静脉注射免疫球蛋白(IVIG)已成功地用于降低MM稳定期的感染率，但在其他阶段的数据有限。我们回顾分析了2006年3月至2009年6月我所收治的47例多发性骨髓瘤患者。所有患者均接受沙利度胺和类固醇治疗至少6个月。由于疾病进展，9名患者在沙利度胺之后接受了波特佐米和11名来那度胺治疗，22名患者接受了ASCT。年龄中位数为(37-86岁)，男女比例为18：29。感染时残留血清免疫球蛋白中位数分别为3.2g/L、0.3g/L、0.2g/L。15名患者患有不同程度的病毒感染。除3名患者外，所有患者都接受了静脉注射免疫球蛋白治疗，此后感染率显著下降(p<；001)。我们的分析表明，使用新的免疫调节药物与类固醇联合治疗的多发性骨髓瘤患者感染风险显著增加。在这群患者中，使用IVIG治疗似乎是预防感染的有效策略。进一步的研究证实这些发现是有必要的。
Multiple myeloma (MM) is associated with a significant risk of infection due to immune dysfunction. Infections are a major cause of morbidity and mortality in MM patients. There are few data available regarding the prevalence of infection in MM patients, especially in conjunction with newer generations of immunomodulatory drugs (thalidomide, bortezomib, lenalidomide) or post autologous stem cell transplantation (ASCT). Intravenous immunoglobulin (IVIG) has been used successfully to reduce infection rates in the stable phase of MM, with limited data in other stages. We retrospectively analyzed 47 patients with MM from March 2006 to June 2009 at our institution. All patients received thalidomide and steroid therapy for at least 6 months. Nine patients received bortezomib and 11 lenalidomide subsequent to thalidomide, because of disease progression, and 22 patients underwent ASCT. The median age was 64 years (range 37–86), with a female–to-male ratio of 18:29. The median residual-serum IgG-level at time of infection was 3.2 g/L, IgA 0.3 g/L and IgM 0.2 g/L. Most patients suffered from recurrent moderate to severe bacterial infections, including the ASCT group. Fifteen patients suffered from different degrees of viral infections. All patients except 3 received IVIG therapy with a significant decline of the rate of infection thereafter (p<001). Our analysis shows that patients with MM treated with the new immunomodulatory drugs in conjunction with steroids are at significant increased risk of infection. Employing IVIG therapy appears to be an effective strategy to prevent infection in this cohort of patients. Further studies to confirm these findings are warranted.