Role of Gamma Globulin for Immunoprophylaxis in Multiple Myeloma

Salmon, Sydney E.; Samal, Bohumil A.; Hayes, D. S.; Hosley, Henry F.; Miller, Sherwood P.; Schilling, Albert

doi:10.1056/nejm196712212772503

Cited by 59 publications

(12 citation statements)

References 10 publications

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“…Our calculations on the subclinical phase of disease (up to 2.5 X 1011 cells) suggest that this initial period of tumor growth occurs in from less than 4 Should a feedback inhibitor produced by myeloma cells also affect normal antibody-producing clones, then one major clinical feature of myeloma may be clarified. An antibody-deficiency syndrome is a constant feature of this disorder; it appears to be due to a reduction in the number of normal-immunoglobulin-producing clones rather than a change in immunoglobulin catabolism (33)(34)(35). Extrapolating from our measurements in myeloma, we calculate that the mass of all antibodyproducing clones in normal man is some 3 X 1011 cells (about 300 g).…”

Section: Theoretical Backgroundmentioning

confidence: 80%

Kinetics of tumor growth and regression in IgG multiple myeloma

Sullivan¹,

Salmon²

1972

J. Clin. Invest.

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195

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A B S T R A C T Studies of immunoglobulin synthesis, total body tumor cell number, and tumor kinetics were carried out in a series of patients with IgG multiple myeloma. The changes in tumor size associated with tumor growth or with regression were underestimated when the concentration of serum M-component was used as the sole index of tumor mass. Calculation of the total body M-component synthetic rate (corrected for concentration-dependent changes in IgG metabolism) and tumor cell number gave a more accurate and predictable estimate of changes in tumor size. Tumor growth and drug-induced tumor regression were found to follow Gompertzian kinetics, with progressive retardation of the rate of change of tumor size in both of these circumstances. This retardation effect, describable with a constant a, may be caused by a shift in the proportion of tumor cells in the proliferative cycle. Drug sensitivity of the tumor could be described quantitatively with a calculation of Bo, the tumor's initial sensitivity to a given drug regimen. Of particular clinical significance, the magnitude of a given patient's tumor regression could be predicted from the ratio of This work was presented in part at

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Section: Theoretical Backgroundmentioning

confidence: 80%

Kinetics of tumor growth and regression in IgG multiple myeloma

Sullivan¹,

Salmon²

1972

J. Clin. Invest.

Self Cite

195

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“…Prophylactic IVIG has been studied in plateau phase following initial treatment with some benefit in reducing the risk of infection: IVIG has been shown to have some benefit in reducing infection rates in patients in plateau phase, 11 but no effect has been demonstrated in newly diagnosed patients. 12 …”

Section: Discussionmentioning

confidence: 99%

Oral antibiotic prophylaxis of early infection in multiple myeloma: a URCC/ECOG randomized phase III study

et al. 2012

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Multiple myeloma (MM) is a malignancy of clonal plasma cells, resulting in an increased production of ineffective immunoglobulins with suppression of non-involved immunoglobulins. Patients with MM are at increased risk of infectious complications, particularly streptococcal and staphylococcal infections. This study evaluated the impact of prophylactic antibiotics on the incidence of serious bacterial infections (SBIs) during the first 2 months of treatment in patients with newly diagnosed MM. Patients with MM receiving initial chemotherapy were randomized on a 1:1:1 basis to daily ciprofloxacin (C; 500 mg twice daily), trimethoprim-sulfamethoxazole (T; DS twice daily) or observation (O) and evaluated for SBI (Eastern Cooperative Oncology Group ⩾grade 3) for the first 2 months of treatment. From July 1998 to January 2008, 212 MM patients were randomized to C (n = 69), T (n = 76) or O (n = 67). The incidence of SBI was comparable among groups: C = 12.5%, T = 6.8% and O = 15.9%; P = 0.218. Further, any infection during the first 2 months was also comparable (20% vs 23% vs 22%, respectively, P = 0.954). We demonstrate that prophylactic antibiotics did not decrease the incidence of SBI (⩾grade 3) within the first 2 months of treatment. We conclude that routine use of prophylactic antibiotics should not be mandated for patients receiving induction chemotherapy.

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“…90 Regarding vaccinations, myeloma patients show suboptimal antibody responses to several vaccines; the responses seem to be worse for polysaccharide than protein antigens. 91 In addition, all patients who undergo allogeneic SCT should receive vaccinations for Haemophilus influenzae type b, pertussis, pneumococci, meningococci, tetanus, diphtheria, hepatitis A and B, measles, mumps and rubella, influenza, poliomyelitis, varicella-zoster virus, human papilloma virus, and tick-borne encephalitis with a particular focus on vaccination of patients with active chronic graft-versus-host disease (GvHD).…”

Section: E Terpos Et Almentioning

confidence: 99%