Cesana Clara, Nosari Anna Maria, Klersy Catherine, Miqueleiz Sara, Rossi Valentina, Ferrando Paola, Valentini Marina, Barbarano Luciana, Morra Enrica
Dept.. of Hematology, Bone Marrow Transplantation Center, Niguarda Cà Granda Hospital, Milan, Italy.
Haematologica. 2003 Sep;88(9):1022-8.
We evaluated bacterial infections (BIs) in patients with multiple myeloma (MM) treated with two different schedules of vincristine-adriamycin-dexamethasone (VAD).
Ninety-seven patients were studied during 340 VAD cycles. VAD was given by either continuous intravenous infusion (CII) to hospitalized patients or rapid intravenous infusion (RII) to outpatients. The characteristics of patients and VAD schedules were retrospectively analyzed to detect correlations with the incidence of BI.
By analyzing each VAD cycle, we found that profound hypogammaglobulinemia (p=0.06) and post-treatment neutropenia (p=0.08) were associated with a trend for a higher risk of infection, while renal function impairment was significantly correlated with BI risk at both univariate (p<0.02) and multivariate (p<0.002) analyses. Evaluating only the first 4 months of therapy, characterized by a significantly higher incidence of BI than the later period (p<0.0001), previously untreated disease was significantly correlated with BI risk (p<0.04), while male sex (p=0.06), CII schedule (p=0.07), and profound hypogammaglobulinemia (p=0.1) were associated with a tendency to a higher risk of infection; however, at multivariate analysis the latter two parameters independently predicted BI probability (p<0.015 and p<0.03, respectively) as did previously untreated disease (p<0.025). The high probability of CII-related infection was demonstrated to depend on the frequent development of nosocomial infections.
Patients with profound hypogammaglobulinemia who receive VAD as first line treatment are at a major risk of BI up to the completion of the fourth month of therapy. In this setting hospitalization should be avoided and, if patients require admission, antibacterial prophylaxis with intravenous immunoglobulins could be appropriate and effective.
我们评估了接受两种不同剂量长春新碱-阿霉素-地塞米松（VAD）方案治疗的多发性骨髓瘤（MM）患者的细菌感染（BI）情况。
在340个VAD疗程中对97例患者进行了研究。住院患者接受持续静脉输注（CII）的VAD治疗，门诊患者接受快速静脉输注（RII）的VAD治疗。对患者特征和VAD方案进行回顾性分析，以检测与BI发生率的相关性。
通过分析每个VAD疗程，我们发现严重低丙种球蛋白血症（p = 0.06）和治疗后中性粒细胞减少（p = 0.08）与感染风险升高趋势相关，而肾功能损害在单因素分析（p < 0.02）和多因素分析（p < 0.002）中均与BI风险显著相关。仅评估治疗的前4个月，该阶段BI发生率显著高于后期（p < 0.0001），初治疾病与BI风险显著相关（p < 0.04），而男性（p = 0.06）、CII方案（p = 0.07）和严重低丙种球蛋白血症（p = 0.1）与感染风险升高趋势相关；然而，在多因素分析中，后两个参数以及初治疾病均独立预测了BI概率（分别为p < 0.015、p < 0.03和p < 0.025）。CII相关感染的高概率被证明取决于医院感染的频繁发生。
接受VAD一线治疗的严重低丙种球蛋白血症患者在治疗的前4个月内发生BI的风险较高。在这种情况下应避免住院，如果患者需要入院，静脉注射免疫球蛋白进行抗菌预防可能是合适且有效的。
