The majority of patients with newly diagnosed multiple myeloma (MM) have immunoparesis, which is the suppression of normal polyclonal immunoglobulins. It had not been clearly proven that immunoparesis at diagnosis and, more specifically, its recovery after therapy were related to survival in patients who cannot have an autologous stem-cell transplant (ASCT).

With a median overall survival of 36 months [95% CI: 31-40], the retrospective analysis assessed the effects of immunoparesis in 431 patients with MM who were ineligible for ASCT. At diagnosis, immunoparesis was found in 81.2% of patients, and it was linked to a trend toward a worse overall response rate (ORR: 84.8% vs. 74.9%; OR 1.88 (95% CI: 0.97-3.63)), a shorter progression-free survival (PFS) period (22.0 vs. 18.2 months; hazard ratio (HR) 0.775; 95% CI: 0.590-1.018; P=0.066) and overall survival (OS) (45.9 vs. 34.2 months; HR 0.746; 95% CI: 0.551–1.010; P=0.057).

In the time after diagnosis, polyclonal immunoglobulins were restored in 24% of patients who had immunoparesis. It’s interesting to note that these patients outperformed individuals who did not regain it in terms of ORR (96.3% vs. 68.2%; OR 12.29 (95% CI: 3.77-40.06), PFS (HR 0.703; 95 CI%: 0.526-0.941; P=0.018), and OS (HR 0.678; 95CI%: 0.503-0.913; P=0.011).

In conclusion, improved results were seen when patients with MM who were not undergoing ASCT also received first-line therapy while reestablishing a robust immune system.

Reference: onlinelibrary.wiley.com/doi/10.1111/bjh.18182