Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain; Immunodeficiency Interdepartmental Group, (GIID), Madrid, Spain.
Department of Haematology, Hospital Clínico San Carlos, Madrid, Spain.
Clin Immunol. 2020 Jan;210:108307. doi: 10.1016/j.clim.2019.108307. Epub 2019 Nov 21.
An increasing healthcare challenge in the management of haematological malignancy (HM) is secondary immunodeficiency. From January 2019, the EMA included the evaluation of specific antibody (Ab) responses to better select patients for immunoglobulin replacement therapy (IgRT). We evaluated Ab responses to pneumococcal and Salmonella typhi pure polysaccharide immunization in a cohort of 42 HM patients and 24 healthy-controls. Pre-post specific Ab concentrations were measured by ELISA at 4 weeks. Globally, significantly lower Typhim Vi (TV) seroprevalence (9%) compared to 23-valent pneumococcal polysaccharide vaccine (PPV) (76%) (p <0.001) was observed. TV non responders (88%) were higher than PPV non responders (62%) (p <0.0001) and correlated better to infectious history. By ROC analysis, pre-post 5-fold TV increase was the best cut-off to discriminate HM with recurrent infections and controls (sensitivity 91%, specificity 100%). Despite the small sample cohort, our results suggest that specific anti-S typhi Ab response is a useful complementary assay in the diagnosis and management decision of SID to HM.
在血液恶性肿瘤（HM）的管理中，继发性免疫缺陷是一个日益严峻的医疗挑战。自 2019 年 1 月起，EMA 已将特定抗体（Ab）反应的评估纳入其中，以更好地选择接受免疫球蛋白替代治疗（IgRT）的患者。我们评估了 42 例 HM 患者和 24 例健康对照者对肺炎球菌和伤寒沙门氏菌纯多糖免疫的 Ab 反应。在 4 周时通过 ELISA 测量 Ab 浓度的前后变化。总的来说，与 23 价肺炎球菌多糖疫苗（PPV）（76%）相比，Typhim Vi（TV）血清阳性率（9%）明显较低（p<0.001）。TV 无反应者（88%）高于 PPV 无反应者（62%）（p<0.0001），且与感染史相关性更好。通过 ROC 分析，前后 5 倍 TV 增加是区分 HM 患者复发性感染和对照组的最佳截断值（敏感性 91%，特异性 100%）。尽管样本量较小，但我们的结果表明，针对伤寒沙门氏菌的特异性抗 Ab 反应是诊断和管理 HM 患者 SID 的一种有用的补充检测方法。
