Lancman Guido, Lozada Katleen, Athar Nida, Jacobs Samantha, Doucette John, Cho Hearn Jay, Jagannath Sundar, Madduri Deepu, Parekh Samir, Richard Shambavi, Richter Joshua, Chari Ajai
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Icahn School of Medicine at Mount Sinai, New York, NY.
Clin Lymphoma Myeloma Leuk. 2021 May;21(5):e470-e476. doi: 10.1016/j.clml.2020.12.026. Epub 2021 Feb 7.
Despite many recent advances in the treatment of multiple myeloma (MM), infection remains a major cause of morbidity and mortality. Prior studies have shown mixed results using intravenous immunoglobulin (IVIG) to prevent infections in MM and were conducted prior to most modern MM therapies.
We retrospectively reviewed all patients with MM treated with IVIG at our institution from 2010 to 2017. The primary endpoint was the incidence rate ratio (IRR) of infectious events (IEs) per patient-year during IVIG versus observation.
A total of 68 patients were included; 151 IEs occurred during 918 months of IVIG treatment, whereas 446 IEs occurred during 2484 months of observation. Although the annual rate of IEs was substantially higher during periods of progressive disease (PD) compared with non-PD (4.9 vs. 1.8; P < .001), most IEs occurred during periods of non-PD (75% vs. 25% during PD). There was no overall difference in the annual rate of IEs per patient between IVIG and observation (1.97 vs. 2.16; IRR, 0.92; 95% confidence interval [CI], 0.76-1.10; P = .376). The subgroup of patients with hypogammaglobulinemia and whose myeloma was in a non-PD phase had a significant reduction in all-grade IEs (1.20 vs. 1.92; IRR, 0.63; 95% CI, 0.45-0.88; P = .009) and ≥ grade 3 IEs (0.25 vs. 0.56; IRR, 0.45; 95% CI, 0.22-0.94; P = .041) with IVIG compared with observation.
Although treatment with IVIG did not show benefit in the overall population, there may be subgroups of patients that derive significant benefit. Additional observational studies are needed to confirm these findings and further refine patient selection.
尽管近年来多发性骨髓瘤（MM）的治疗取得了许多进展，但感染仍然是发病和死亡的主要原因。先前的研究在使用静脉注射免疫球蛋白（IVIG）预防MM感染方面结果不一，且这些研究是在大多数现代MM疗法出现之前进行的。
我们回顾性分析了2010年至2017年在我院接受IVIG治疗的所有MM患者。主要终点是IVIG治疗期间与观察期间每位患者每年感染事件（IE）的发病率比（IRR）。
共纳入68例患者；在918个月的IVIG治疗期间发生了151次IE，而在2484个月的观察期间发生了446次IE。尽管与非疾病进展期（非PD）相比，疾病进展期（PD）的IE年发生率显著更高（4.9对1.8；P <.001），但大多数IE发生在非PD期（PD期为25%，非PD期为75%）。IVIG组与观察组每位患者的IE年发生率无总体差异（1.97对2.16；IRR为0.92；95%置信区间[CI]为0.76 - 1.10；P =.376）。低丙种球蛋白血症且骨髓瘤处于非PD期的患者亚组，与观察组相比，IVIG治疗使所有级别IE显著减少（1.20对1.92；IRR为0.63；95%CI为0.45 - 0.88；P =.009），≥③级IE也显著减少（0.25对0.56；IRR为0.45；95%CI为0.22 - 0.94；P =.041）。
尽管IVIG治疗在总体人群中未显示出益处，但可能有部分患者亚组能从中显著获益。需要更多观察性研究来证实这些发现并进一步优化患者选择。
