Role of Suppressed Immunoglobulins in Outcome of Patients With Multiple Myeloma

Introduction: Multiple myeloma (MM) is typically presented with abundant monoclonal secretion of one type of immunoglobulin. The other classes of immunoglobulins, which are uninvolved and not secreted by malignant plasma cells, could be decreased. A number of previous studies reported the effect of suppression of uninvolved immunoglobulins on the outcome of patients with myeloma. However, its effect in regard to the type of treatment was not studied so far. The current study aimed at investigating the effect of uninvolved immunoglobulins suppression on the outcome of patients with myeloma in each individual type of treatment. Methods: In the current retrospective study, 140 myeloma cases diagnosed from 1999 to 2016 were studied. Patients were divided into 2 groups according to the first-line chemotherapy: 58 cases treated with Velcade-based and 81 cases with other agents. In the 2 groups, the effects of immunoglobulin suppression as well as other prognostic parameters on overall survival (OS) and progression-free survival (PFS) were evaluated. Results: The effect of immunoglobulin suppression on patients’ outcome depended on the type of treatment. In the Velcade group, suppression of at least 2 classes of immunoglobulins was significantly related to poorer survival in terms of both OS and PFS. In the non-velcade group, suppression of immunoglobulins showed no significant relationship with OS or PFS. Conclusions: For cases treated with Velcade, suppression of 2 types of immunoglobulins was related to poorer outcomes. Based on the results of the current study, it seemsed that immunoglobulin suppression was a predictive factor rather than a prognostic one. More studies with a larger sample size should be conducted to assess the outcome of patients treated with Velcade and severely suppressed immunoglobulins.