文章：

多发性骨髓瘤患者疾病初发、治疗应答及缓解期的抗菌抗体：对患者管理的启示

Anti-bacterial antibodies in multiple myeloma patients at disease presentation, in response to therapy and in remission: implications for patient management

原文发布日期：2020-11-04

DOI: 10.1038/s41408-020-00370-7

类型: Article

开放获取: 是

英文摘要：

Multiple myeloma (MM) is associated with increased risk of infection, but little is known regarding antibody levels against specific bacteria. We assessed levels of polyclonal immunoglobulin and antibacterial antibodies in patients recruited to the TEAMM trial, a randomised trial of antibiotic prophylaxis at the start of anti-myeloma treatment. Polyclonal IgG, IgA and IgM levels were below the reference range in 71%, 83% and 90% of 838 MM patients at diagnosis. Anti-vaccine targeted tetanus toxoid antibodies were protective in 95% of 193 healthy controls but only 41% of myeloma patients. In healthy controls, protective antibodies against 6/12 pneumococcal serotypes, haemophilus and meningococcus A were present in 67%, 41% and 56% compared to just 15%, 21% and 17% of myeloma patients. By 1 year, myeloma patients IgG levels had recovered for 57% of patients whilst the proportion with protective levels of IgG against thymus-dependent protein antigen tetanus toxoid had changed little. In contrast the proportions of patients with protective levels against thymus independent polysaccharide antigens pneumococcus, haemophilus and meningococcus had fallen from 15 to 7%, 21 to 0% and 17 to 11%. Findings highlight the need for strategies to protect patients against bacterial infections during therapy and vaccination programmes during remission.
 

摘要翻译： 

多发性骨髓瘤患者感染风险增高，但其针对特定细菌的抗体水平所知甚少。我们在TEAMM试验（一项在抗骨髓瘤治疗初期使用抗生素预防的随机试验）入组患者中评估了多克隆免疫球蛋白及抗菌抗体水平。在838名新确诊的多发性骨髓瘤患者中，多克隆IgG、IgA和IgM水平低于参考范围的比例分别为71%、83%和90%。193名健康对照者中95%具有保护水平的抗破伤风类毒素疫苗抗体，而骨髓瘤患者中仅41%达到保护水平。健康对照组中对6/12肺炎球菌血清型、流感嗜血杆菌和A群脑膜炎球菌具有保护性抗体的比例分别为67%、41%和56%，而骨髓瘤患者中相应比例仅为15%、21%和17%。治疗一年后，57%的骨髓瘤患者IgG水平恢复，但针对胸腺依赖性蛋白抗原破伤风类毒素具有保护性IgG水平的患者比例变化甚微。相比之下，针对胸腺非依赖性多糖抗原（肺炎球菌、流感嗜血杆菌和脑膜炎球菌）具有保护性抗体水平的患者比例从15%降至7%、21%降至0%、17%降至11%。这些发现提示需要采取策略在治疗期间保护患者免受细菌感染，并在缓解期实施疫苗接种计划。

原文链接：

Anti-bacterial antibodies in multiple myeloma patients at disease presentation, in response to therapy and in remission: implications for patient management