Chahin Michael, Branham Zachery, Fox Ashley, Leurinda Christian, Keruakous Amany R
Section of Hematology and Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA.
Internal Medicine, Augusta University, Augusta, GA 30912, USA.
Cancers (Basel). 2022 May 3;14(9):2278. doi: 10.3390/cancers14092278.
Multiple myeloma is a relatively common clonal plasma cell disorder, comprising 17% of hematologic malignancies. One of the hallmark features of this disease is immunoparesis, which is characterized by the suppression of immunoglobulin polyclonality. Though not entirely elucidated, the mechanism behind this process can be attributed to the changes in the tumor microenvironment. All treating clinicians must consider potential complications related to immunoparesis in the management of multiple myeloma. Though not explicitly described in large data series, the increased risk of infection in multiple myeloma is likely, at least in part, due to immunoglobulin suppression. Additionally, the presence of immunoparesis serves as a prognostic factor, conveying poorer survival and a higher risk of relapse. Even in the era of novel agents, these findings are preserved, and immunoglobulin recovery also serves as a sign of improved outcome following autologous HSCT. Though not within the diagnostic criteria for multiple myeloma, the presence and degree of immunoparesis should be at diagnosis for prognostication, and immunoglobulin recovery should be tracked following myeloablative therapy and autologous HSCT.
多发性骨髓瘤是一种相对常见的克隆性浆细胞疾病，占血液系统恶性肿瘤的17%。该疾病的标志性特征之一是免疫球蛋白减少，其特征是免疫球蛋白多克隆性受到抑制。尽管这一过程背后的机制尚未完全阐明，但可归因于肿瘤微环境的变化。所有参与治疗的临床医生在多发性骨髓瘤的管理中都必须考虑与免疫球蛋白减少相关的潜在并发症。虽然在大型数据系列中没有明确描述，但多发性骨髓瘤患者感染风险增加可能至少部分归因于免疫球蛋白抑制。此外，免疫球蛋白减少的存在是一个预后因素，提示生存率较低和复发风险较高。即使在新型药物时代，这些发现依然存在，免疫球蛋白恢复也是自体造血干细胞移植后预后改善的标志。尽管免疫球蛋白减少不在多发性骨髓瘤的诊断标准范围内，但在诊断时应确定其存在和程度以进行预后评估，并且在清髓性治疗和自体造血干细胞移植后应跟踪免疫球蛋白的恢复情况。
