Immune parameters in multiple myeloma patients: influence of treatment and correlation with opportunistic infections.
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.
Schütt
Philipp
P
Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen Medical School, Essen, Germany. philipp.schuett@uni-essen.de
Brandhorst
Dieter
D
Stellberg
Werner
W
Poser
Miriam
M
Ebeling
Peter
P
Müller
Siemke
S
Buttkereit
Ulrike
U
Opalka
Bertram
B
Lindemann
Monika
M
Grosse-Wilde
Hans
H
Seeber
Siegfried
S
Moritz
Thomas
T
Nowrousian
Mohammad R
MR
D000368:Aged; D000917:Antibody Formation; D015703:Antigens, CD / Q000032:analysis; D018941:Antigens, CD19; D000970:Antineoplastic Agents / Q000494:pharmacology; D015496:CD4-Positive T-Lymphocytes; D002478:Cells, Cultured; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007111:Immunity, Cellular; D007132:Immunoglobulin Isotypes / Q000097:blood*; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000473:pathology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000276:immunology* / Q000473:pathology; D009894:Opportunistic Infections / Q000209:etiology*
D015703:Antigens, CD; D018941:Antigens, CD19; D000970:Antineoplastic Agents; D006684:HLA-DR Antigens; D007132:Immunoglobulin Isotypes