title: Immune parameters in multiple myeloma patients: influence of treatment and correlation with opportunistic infections.
abstract: 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.
authors.affiliation: Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen Medical School, Essen, Germany. philipp.schuett@uni-essen.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Schütt
authors.forename: Dieter
authors.initials: D
authors.lastname: Brandhorst
authors.forename: Werner
authors.initials: W
authors.lastname: Stellberg
authors.forename: Miriam
authors.initials: M
authors.lastname: Poser
authors.forename: Peter
authors.initials: P
authors.lastname: Ebeling
authors.forename: Siemke
authors.initials: S
authors.lastname: Müller
authors.forename: Ulrike
authors.initials: U
authors.lastname: Buttkereit
authors.forename: Bertram
authors.initials: B
authors.lastname: Opalka
authors.forename: Monika
authors.initials: M
authors.lastname: Lindemann
authors.forename: Hans
authors.initials: H
authors.lastname: Grosse-Wilde
authors.forename: Siegfried
authors.initials: S
authors.lastname: Seeber
authors.forename: Thomas
authors.initials: T
authors.lastname: Moritz
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Nowrousian
mesh_terms: 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*
chemical_list: D015703:Antigens, CD; D018941:Antigens, CD19; D000970:Antineoplastic Agents; D006684:HLA-DR Antigens; D007132:Immunoglobulin Isotypes