Antibody Response to Infection in Multiple Myeloma Implications
for Vaccination
CfIARLES M. NOLAN, M.D. PALJL 1, BAXLEY, M.D.*
l,ittle Rock, Arkansas CARL E. FRASCH, Ph.D. Jjethesdu. Muryland
We report the humoral immune response of a patient with multiple myeloma to rapidly successive episodes of meningococcal and pneumococcal meningitis. Specific antibody responses included a high bactericidal titer (1:640) against the itifecting meningococcus and a sharp increase (from 196 to 6,097 ng/ml antibody nitrogen) in antibody to the type-specific capsular polysaccharide of the infecting pneumococcus. These data, showing the prqduction of protective antibodies against the two pathogens, suggest that some fliitients with multiple myeloma might also respond to appropriately administered bacterial vaccines. This fact should be ascertained because vaccination could potentially reduce the high rate of bacterial irifections associated with this disease. Patients with multiple myeloma are subject to infections due to bacteria, such as Streptococcus pneumoniae, against which circulating antibodies play a protective role [1,2]. Although effective vaccines against pneumococci and other bacterial pathogens are now available [3-s], there is reason for pessimism regarding their value in patients with multiple myeloma, because these subjects often fail to produce antibodies in response to challenge with bacterial antigens [2,6]. We recently had the opportunity to record the humoral immune response to natural infection in a patient with multiple myeloma who sustained rapidly successive episodes of meningococcal and pneumococcal meningitis. The patient produced antibodies normally during both infections, a fact which suggests that some patients with multiple myeloma might also respond to appropriately adniinistered bacterial vaccines. CASE REPORT
From the Department of Medicine, University of Arkansas College of Medicing. Little Rock, Arkansas; and the Division of Bacterial Products, Bureau of Biologics, Food and Drug Administration, Bethesda, Maryland. Requests for reprints should be addressed to Dr. Charles M. Nolan, Department of Medicine, Mail Slot 519, LJnivcrsity of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, Arkansas 72201. Manuscript accepted December 7.1978. * Present address: 17th and Harrison, Batesville, Arkansas 72501.
A 60 year old white man was admitted to the Little Rock Veterans Administration Hospital (LRVAH) because of vomiting, fever and confusion for 36 hours. The patient was lethargic, but oriented. Petechiae were present over the abdomen, and there was nuchal rigidity. The hemoglobin concentration was 9.0 g/dl, the hematocrit value 26 per cent, white blood cell count 2,9OO/ml with 58 per cent polymorphonuclear leukocytes, and the platelet count was 64,00O/ml. The creatinine was 1.3 mg/dl, calcium 11.8 mg/dl, phosphate 1.4 mg/dl and the total protein concentration 7.2 g/dl; albumin 1.8 g/dl. There was trace proteinuria. Cerebrospinal fluid contained 1,819 white cells/ml, 75 per cent polymorphonuclear leukocytes: gram-negative diplococci were seen on a gram-stained smear of cerebrospinal fluid. Neisseria meningitidis. group B, was cultured from cerebrospinal fluid and blood. Penicillin G, 20 million U/day, was infused intravenously. There was a good clinical response, and the antibiotic was discontinued after 14 days of therapy.
August 1979 The American Journal of Medicine
Volume 67
331
ANTIBODY
RESPONSE
TO INFECTION
TABLE I
l
IN MlJLTlPLE
MYELOMA-NOLAN
Antibody Response Resulting From Group B Meningocbccal Meningitis
Serum Specimen
Bactericidal Titer to tnlecting Organism (nl* \
for Vaccination
CfIARLES M. NOLAN, M.D. PALJL 1, BAXLEY, M.D.*
l,ittle Rock, Arkansas CARL E. FRASCH, Ph.D. Jjethesdu. Muryland
We report the humoral immune response of a patient with multiple myeloma to rapidly successive episodes of meningococcal and pneumococcal meningitis. Specific antibody responses included a high bactericidal titer (1:640) against the itifecting meningococcus and a sharp increase (from 196 to 6,097 ng/ml antibody nitrogen) in antibody to the type-specific capsular polysaccharide of the infecting pneumococcus. These data, showing the prqduction of protective antibodies against the two pathogens, suggest that some fliitients with multiple myeloma might also respond to appropriately administered bacterial vaccines. This fact should be ascertained because vaccination could potentially reduce the high rate of bacterial irifections associated with this disease. Patients with multiple myeloma are subject to infections due to bacteria, such as Streptococcus pneumoniae, against which circulating antibodies play a protective role [1,2]. Although effective vaccines against pneumococci and other bacterial pathogens are now available [3-s], there is reason for pessimism regarding their value in patients with multiple myeloma, because these subjects often fail to produce antibodies in response to challenge with bacterial antigens [2,6]. We recently had the opportunity to record the humoral immune response to natural infection in a patient with multiple myeloma who sustained rapidly successive episodes of meningococcal and pneumococcal meningitis. The patient produced antibodies normally during both infections, a fact which suggests that some patients with multiple myeloma might also respond to appropriately adniinistered bacterial vaccines. CASE REPORT
From the Department of Medicine, University of Arkansas College of Medicing. Little Rock, Arkansas; and the Division of Bacterial Products, Bureau of Biologics, Food and Drug Administration, Bethesda, Maryland. Requests for reprints should be addressed to Dr. Charles M. Nolan, Department of Medicine, Mail Slot 519, LJnivcrsity of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, Arkansas 72201. Manuscript accepted December 7.1978. * Present address: 17th and Harrison, Batesville, Arkansas 72501.
A 60 year old white man was admitted to the Little Rock Veterans Administration Hospital (LRVAH) because of vomiting, fever and confusion for 36 hours. The patient was lethargic, but oriented. Petechiae were present over the abdomen, and there was nuchal rigidity. The hemoglobin concentration was 9.0 g/dl, the hematocrit value 26 per cent, white blood cell count 2,9OO/ml with 58 per cent polymorphonuclear leukocytes, and the platelet count was 64,00O/ml. The creatinine was 1.3 mg/dl, calcium 11.8 mg/dl, phosphate 1.4 mg/dl and the total protein concentration 7.2 g/dl; albumin 1.8 g/dl. There was trace proteinuria. Cerebrospinal fluid contained 1,819 white cells/ml, 75 per cent polymorphonuclear leukocytes: gram-negative diplococci were seen on a gram-stained smear of cerebrospinal fluid. Neisseria meningitidis. group B, was cultured from cerebrospinal fluid and blood. Penicillin G, 20 million U/day, was infused intravenously. There was a good clinical response, and the antibiotic was discontinued after 14 days of therapy.
August 1979 The American Journal of Medicine
Volume 67
331
ANTIBODY
RESPONSE
TO INFECTION
TABLE I
l
IN MlJLTlPLE
MYELOMA-NOLAN
Antibody Response Resulting From Group B Meningocbccal Meningitis
Serum Specimen
Bactericidal Titer to tnlecting Organism (nl* \
