多发性骨髓瘤相关性感染的防治现状

Current prevention and treatment for multiple myeloma-related infections

骨髓瘤相关性感染(MRIs)直接影响多发性骨髓瘤(MM)病人生存与预后,是MM的首位并发症与死因,其主要机制为MM内在性免疫缺陷与治疗相关性免疫抑制两方面。MRIs发生贯穿于MM诱导、维持及挽救治疗等不同阶段,定期检测降钙素原(PCT)、C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)等炎症指标及胸部CT检查有助于早期判断MRIs发生及程度。MRIs以细菌感染与肺部感染最常见,又以治疗初2月内发生率最高。预防性抗生素治疗仅应用于发生严重感染及中性粒细胞减少性发热的高危MM人群,而预防性抗病毒治疗主要用于接受自体干细胞移植与硼替佐米治疗的MM病人。粒细胞集落刺激因子(G-CSF)尤其是长效G-CSF制剂在预防MRIs发生具有肯定疗效,可作为MRIs的主要方法。

Myeloma-related infections(MRIs)directly affect the survival and prognosis of patients with multiple myeloma(MM),occupying the first complication and cause of death of MM.The main mechanisms of MRIs are ascribed to intrinsic immune dysfunction and therapy-related immunosuppression.MRIs run through the total course including induction,maintenance and salvage treatments.Regular testing procalcitonin(PCT),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and chest computer tomography(CT)contribute to early judgement of MRIs'occurrence as well as its degree.Bacterial and lung infections are the most common type of MRIs,which has the highest incidence within the initial 2 months of treatment.Prophylactic antibiotics use has been only approved for those high-risk MM patients with tendency to severe infection and febrile neutropenia.Prophylactic anti-virus agents have been mainly recommended for MM patients treated by autologous stem cell transplantation and bortezomib-base regimens.Granulocyte-colony stimulating factor(G-CSF),especially long-acting G-CSF preparations,has a positive effect in preventing the occurrence of MRIs and can be used as the main method for MRIs.