Immunological factors and risk of infection in plateau phase myeloma.

Abstract

Aims-A series of patients with myeloma were investigated to assess whether immunological risk factors predisposing to serious infection could be identified. Methods-Patients (n = 102) with predominantly plateau phase myeloma were monitored prospectively for infections. Immunological parameters including total non-paraprotein immunoglobulins and specific antibody titres were measured in all patients and compared with a control population ofhealthy individuals of a similar age; response to immunisation with Pneumovax II, tetanus and diphtheria toxoids and IgG subclasses were measured in a subgroup of 41 patients. Other characteristics investigated for any association with infection included age, sex, paraprotein type, disease stage, and chemotherapy. Results-Specific antibody titres to pneumococcal capsular polysaccharides and tetanus and diphtheria toxoids were significantly reduced compared with the control population. Low antipneumococcal and anti Escherichia coli titres correlated with risk of serious infection and low antipneumococcal titres with severity of nonparaprotein immunosuppression. In 41 immunised patients responses to Pneumovax II, tetanus and diphtheria toxoids were poor; IgG subclass levels were significantly reduced and a poor IgG response to Pneumovax II immunisation was associated with an increased risk of septicaemia and low IgG2 levels. The overall serious infection rate was 0'92 infections per patient year and was four times higher during periods of active disease (1.90) compared with plateau phase myeloma (0.49). The predominant site of infection was the respiratory tract. Clinical and laboratory parameters showed only male sex and reduced non-paraprotein IgG and IgA levels to be significantly associated with at least one serious infection. Conclusions-A subgroup of patients with myeloma with poor IgG responses to exogenous antigens, who are at increased risk of serious infection, can be identified and may benefit from replacement immunoglobulin therapy to reduce the risk of infection. (J Clin Pathol 1995;48:260-266)

Comparative Study of Immune Status to Infectious Agents in Elderly Patients with Multiple Myeloma, Waldenstrom's Macroglobulinemia, and Monoclonal Gammopathy of Undetermined Significance

“…Low baseline antibody titers to pneumococci have previously been found in MM patients (20,33) and have been associated with increased risk of serious infection (20). In our study, significantly lower titers were demonstrated in both MM and WM groups than in healthy controls, which fits with the documented susceptibility of these patients to pneumococcal infections (7,23,29).…”

“…In our study, significantly lower titers were demonstrated in both MM and WM groups than in healthy controls, which fits with the documented susceptibility of these patients to pneumococcal infections (7,23,29). It also highlights the issue of vaccination in these patient groups; however, previous studies on pneumococcal vaccination in MM patients have had discouraging results (20,33). Our control group displayed a high median titer against pneumococci in comparison to adult titers reported in a previous study (34).…”

“…These types of patients have been less studied than transplant recipients. Nevertheless, although higher infection rates among MM patients are correlated with active disease and ongoing chemotherapy (7,20), a continuous increased risk of infection has been shown in patients with plateau phase myeloma and was typically associated with poor IgG antibody production (20). The depressed humoral immunity seen in the three patient groups studied is partly a function of the subnormal serum IgG levels displayed by a large proportion of the patients.…”

Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients

“…9,10 It has also been shown that multiple myeloma patients display a low immune response to infections and vaccines, and that it also predicted a higher risk of infection. 11,12 In addition to the inherent immunodeficiency, some small studies have described a changing spectrum of infections in MM, possibly related to the more intensive treatment approach of recent years, suggesting that the novel agents may increase the risk of infections in MM patients. [13][14][15][16] Several studies have indicated that elderly MM patients in particular are highly susceptible to infections.…”

Poor Correlation between Pneumococcal IgG and IgM Titers and Opsonophagocytic Activity in Vaccinated Patients with Multiple Myeloma and Waldenstrom's Macroglobulinemia

“…Pneumococcal vaccination is recommended for myeloma patients even though they are known to be poor responders as defined by poor IgG responses postvaccination measured by enzyme-linked immunosorbent assay (ELISA) (1,(10)(11)(12)(13). In a report of a previous study, we stated that pneumococcal vaccination evoked poor responses not only in MM patients but also in elderly patients with WM and MGUS compared to a control group consisting of subjects within the same age range but without hematological disorders (14).…”