Perri R T, Hebbel R P, Oken M M
Am J Med. 1981 Dec;71(6):935-40. doi: 10.1016/0002-9343(81)90303-x.
The clinical course of 60 patients with multiple myeloma was examined for risk factors associated with infection. The overall incidence of infusion was 1.46 per patient-year. The greatest risk period for the occurrence of infection was the first two months after the start of initial chemotherapy. The incidence of infection during this period was 4.68 infections per patient-year compared with 1.04 infections per patient-year for subsequent months. Serum creatinine levels of 2 mg/dl or more (p less than 0.03) and decreased polyclonal serum immunoglobulins (p less than 0.01) predicted increased risk of early infections. Patients infected during the first two months of initial chemotherapy had the same rate of infection during the subsequent clinical course as did patients free of infection during the early treatment period. Thus, the early risk period does not represent only the attrition of susceptible patients. Patients who achieved an objective response had a decrease in infection risk during the time of the response (0.44 infections per patient-year). While response to chemotherapy prolongs life in multiple myeloma, the initiation of chemotherapy is associated with a definable risk period for infections.
对60例多发性骨髓瘤患者的临床病程进行了检查，以寻找与感染相关的危险因素。感染的总体发生率为每人年1.46次。发生感染的最大风险期是初始化疗开始后的头两个月。在此期间，感染发生率为每人年4.68次感染，而随后几个月为每人年1.04次感染。血清肌酐水平达到2mg/dl或更高（p<0.03）以及多克隆血清免疫球蛋白降低（p<0.01）预示着早期感染风险增加。在初始化疗的头两个月感染的患者在随后的临床病程中的感染率与早期治疗期间未感染的患者相同。因此，早期风险期并不只是代表易感患者的损耗。达到客观缓解的患者在缓解期感染风险降低（每人年0.44次感染）。虽然化疗反应可延长多发性骨髓瘤患者的生命，但化疗开始时存在一个明确的感染风险期。
