title: Effect of immunoglobulin therapy on the rate of infections in multiple myeloma patients undergoing autologous stem cell transplantation or treated with immunomodulatory agents.
abstract: 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.
authors.affiliation: Launceston General Hospital, Launceston, Tasmania.
authors.forename: Alhossain
authors.initials: A
authors.lastname: Khalafallah
authors.forename: Matthias
authors.initials: M
authors.lastname: Maiwald
authors.forename: Amanda
authors.initials: A
authors.lastname: Cox
authors.forename: Denise
authors.initials: D
authors.lastname: Burns
authors.forename: Gerald
authors.initials: G
authors.lastname: Bates
authors.forename: Terry
authors.initials: T
authors.lastname: Hannan
authors.forename: David
authors.initials: D
authors.lastname: Seaton
authors.forename: Bernadene
authors.initials: B
authors.lastname: Fernandopulle
authors.forename: Damien
authors.initials: D
authors.lastname: Meagher
authors.forename: Terry
authors.initials: T
authors.lastname: Brain