[Clinical and Immunological Features of Infectious Complications in Patients with Multiple Myeloma].

Abstract

BACKGROUND Infectious complications--the leading cause of mortality in patients with multiple myeloma (MM), their appearance is regarded as an adverse prognostic factor in the course of the disease. OBJECTIVE The aim of our study was to evaluate the clinical and immunological features of infectious complications in patients with G-immunochemical MM to find the most informative indicators in their forecasting. METHODS A randomized controlled trial was made. All patients were divided into 3 groupsfor comparison: Group 1 (n = 47)--MM patients, G-immunochemical variant with infection, Group 2 (n = 54)--MM patients, G-immunochemical option no infectious complications, and Group 3 (n = 125)--healthy volunteers. Research material was deoxygenated blood taken on admission of a patient to the hematology department before the pathogenetic treatment. Identification of G-variant was carried by immunofixation and electrophoresis. The immune status was assessed by indirect immunofluorescence. The concentration of IgA, M, E and G, and the levels of IL 2, IL 4, IL 8, TNFα, IFNγ in serum was determined by enzyme immunoassay. The activity of neutrophil granulocytes (NG) was studied by chemiluminescent analysis of spontaneous and induced production of reactive oxygen species. Statistical analysis was performed using the software STATISTICA v. 8.0 (USA), RESULTS: We analyzed data from 101 patients with MM and 125 healthy volunteers. The average age of MM patients was 60.53 ± 6.78 years. The group of healthy volunteers was similar in sex and age to groups of patients with MM. In patients with MM in the presence of infectious complications the researchers detected combined secondary development of T and B cell immunodeficiency, changes in non-specific immunity depended on the stage of the disease, unidirectional irregularities in spontaneous and induced chemiluminescence activity NG in II stage disease and multidirectional irregularities in stage III (p = 0.045). Prevalence of the content of proinflammatory cytokines on inflammatory (p < 0.001) and the deviation of the immune response to Th1-type were detected. CONCLUSION the set of 6 informative indicators (the content of IL 4, IL 2, TNF α, IgG, the absolute number of CD4+ and CD19+ cells) enables the development of prediction method of infectious complications in patients with MM.