Severe and continuous immunoparesis during induction or maintenance therapy in nontransplant patients with multiple myeloma is a sign of poor prognosis

Multiple myeloma (MM) varies in clinical behavior, response to treatment and prognosis due to the heterogeneity of the disease. Data on the association between the immunoparesis status during treatment and prognosis in nontransplant MM patients are limited. In a retrospective analysis of 142 patients with MM, we examined the relationship between immunoparesis status and prognosis during treatment. All patients received novel agent-based therapy and did not undergo autologous stem cell transplantation. One, two, or three uninvolved immunoglobulins (Igs) below the lowest thresholds of normalcy were used to identify immunoparesis. Patients with a greater degree of immunoparesis during treatment had shorter progression-free survival (PFS) and overall survival (OS). A total of 46.5% of the patients had severe and continuous immunoparesis (at least two uninvolved Igs suppressed continuously during treatment), representing a worse prognosis than those with complete or partial normalization of Igs during treatment. Among patients who achieved at least complete remission, PFS was poor in patients with severe and continuous immunoparesis. Furthermore, severe and continuous immunoparesis during treatment was a poor prognostic factor for PFS and OS according to multivariate analyses. The degree of immunoparesis during treatment is a follow-up indicator for survival in nontransplant myeloma patients, and severe and continuous immunoparesis in nontransplant myeloma patients might be a sign of poor prognosis.

多发性骨髓瘤(Multiple myeloma, MM)因疾病本身的异质性，其临床行为、治疗应答与预后均存在显著差异。目前针对非移植型多发性骨髓瘤患者治疗期间的免疫麻痹(immunoparesis)状态与预后之间关联的研究数据较为匮乏。本研究对142例多发性骨髓瘤患者开展回顾性分析，探究治疗期间免疫麻痹状态与患者预后的相关性。所有受试者均接受以新型药物为基础的治疗方案，且未接受自体造血干细胞移植(autologous stem cell transplantation)。本研究以至少1、2或3种未受累免疫球蛋白(immunoglobulins, Igs)低于正常下限阈值作为免疫麻痹的判定标准。治疗期间免疫麻痹程度越高的患者，其无进展生存期(progression-free survival, PFS)与总生存期(overall survival, OS)越短。共计46.5%的患者存在重度持续性免疫麻痹（即治疗期间至少2种未受累免疫球蛋白持续受抑），该类患者的预后较治疗期间免疫球蛋白完全或部分恢复正常的患者更差。在达到至少完全缓解的患者亚组中，存在重度持续性免疫麻痹者的无进展生存期同样较差。此外，多因素分析结果显示，治疗期间的重度持续性免疫麻痹是影响患者无进展生存期与总生存期的不良独立预后因素。综上，治疗期间的免疫麻痹程度可作为非移植型多发性骨髓瘤患者生存结局的随访监测指标，而该类患者出现的重度持续性免疫麻痹或可提示不良预后。