RESUMO
Infection of the upper respiratory tract is a major cause of morbidity and mortality in patients with lymphoproliferative syndromes and multiple myeloma. Nebulizations with IgA tested in a randomized double blind trial to evaluate its efficacy to prevent respiratory infections in patients with lymphoproliferative syndromes and multiple myeloma. Forty nine patients were evaluated (chronic lymphocytic leukaemia, 22; multiple myeloma, 11; lymphoma, 8; HCL, 6; Waldenström and lymphoepiteliod tymoma, 1 patient each) were randomized to receive nebulizations every 12 hours during 3 months of IgA or placebo. Seven infectious episodes (4 respiratory tract infections) in 25 IgA treated patients and 25 episodes (16 respiratory tract infections) in 24 control patients were recorded (p <0.0002). Eighteen patients belonging to the treated group remained free of infections against only 5 from the control group (p < 0.001). No difference related to the grade of infections was observed between groups. The arithmetic media for the first infection observed in each group was 45.6 +/- 22.0 days for the IgA treated and 28.6 +/- 17.5 days for the placebo (p < 0.025). According to this study, IgA nebulization therapy was useful to prevent respiratory tract infections and also delay the onset of infection in patients with lymphoproliferative syndromes and myeloma.
Assuntos
Imunoglobulina A/uso terapêutico , Controle de Infecções/métodos , Transtornos Linfoproliferativos/complicações , Mieloma Múltiplo/complicações , Administração Intranasal , Aerossóis , Idoso , Infecções Oculares/complicações , Infecções Oculares/epidemiologia , Infecções Oculares/prevenção & controle , Feminino , Gastroenterite/complicações , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Imunoglobulina A/administração & dosagem , Masculino , Nebulizadores e Vaporizadores , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/prevenção & controle , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controleRESUMO
The potential benefit of interferon (IFN)-alpha therapy in early-stage B cell chronic lymphocytic leukemia (B-CLL) patients is still under discussion, and no assays are available to distinguish potential responders from nonresponders. Herein we analyzed the usefulness of serum tumor necrosis factor (TNF, a cytokine released by CLL cells) and MxA protein (an intracellular marker for biologic activity of endogenous IFN) concentrations as predictive measurements for evolution and response to IFN therapy in early-stage CLL patients. TNF levels and MxA expression were determined at diagnosis in 21 CLL patients. A statistically significant correlation was found between low TNF levels and MxA expression and between high TNF levels and no measurable MxA expression. The patients were then randomized to receive IFN-alpha or no therapy and were evaluated for response and evolution. When response to IFN-alpha therapy was considered, it became apparent that early-stage CLL patients with higher TNF levels and no measurable MxA expression were more likely to benefit from IFN therapy, whereas those patients with lower TNF levels and MxA expression could be considered CLL candidates for longer survival without therapy. More patients have to be tested to strengthen the value of MxA expression and TNF concentrations for subsequent response to IFN-alpha therapy.