John Lukas, Miah Kaya, Benner Axel, Mai Elias K, Kriegsmann Katharina, Hundemer Michael, Kaudewitz Dorothee, Müller-Tidow Carsten, Jordan Karin, Goldschmidt Hartmut, Raab Marc S, Giesen Nicola
Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
Clinical Cooperation Unit Molecular Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
Front Oncol. 2023 Apr 21;13:1078725. doi: 10.3389/fonc.2023.1078725. eCollection 2023.
Infections are a leading cause of morbidity and mortality in patients with multiple myeloma (MM).
To examine the effects of modern second-generation novel agent therapy on immune cell subsets, in particular CD4+-T-cells, and infectious complications in patients with relapsed/refractory MM (RRMM), we conducted a prospective cohort study in 112 RRMM patients.
Substantially decreased CD4+-T-cells <200/µl before initiation of relapse therapy were detected in 27.7% of patients and were associated with a higher number of previous lines of therapy. Relapse therapy with carfilzomib or pomalidomide showed a significant further decrease of CD4+-T-cells. All novel agents led to a significant decrease of B-cell counts. Overall, infections were frequent with 21.3% of patients requiring antibacterial therapy within the first 3 months of relapse therapy, 5.6% requiring hospitalization. However, in the setting of standard antimicrobial prophylaxis in RRMM patients with very low CD4+-T-cells, no significant association of CD4+T-cell count and an increased risk of infection could be detected.
Our findings imply that reduced CD4+-T-cell numbers and infections are common in patients with RRMM. We also demonstrate an association with the number of previous therapies and certain substances suggesting an increased need for personalized prophylaxis strategies for opportunistic infections in this patient cohort.
感染是多发性骨髓瘤（MM）患者发病和死亡的主要原因。
为了研究现代第二代新型药物疗法对复发/难治性MM（RRMM）患者免疫细胞亚群，特别是CD4+ T细胞以及感染并发症的影响，我们对112例RRMM患者进行了一项前瞻性队列研究。
在27.7%的患者中检测到复发治疗开始前CD4+ T细胞显著减少至<200/µl，且与既往治疗线数较多相关。使用卡非佐米或泊马度胺进行复发治疗显示CD4+ T细胞进一步显著减少。所有新型药物均导致B细胞计数显著下降。总体而言，感染很常见，21.3%的患者在复发治疗的前3个月内需要抗菌治疗，5.6%的患者需要住院治疗。然而，在CD4+ T细胞非常低的RRMM患者进行标准抗菌预防的情况下，未检测到CD4+ T细胞计数与感染风险增加之间存在显著关联。
我们的研究结果表明，RRMM患者中CD4+ T细胞数量减少和感染很常见。我们还证明了与既往治疗线数和某些药物之间的关联，这表明该患者队列对机会性感染的个性化预防策略的需求增加。
