Analysis Of Characteristics And Clinical Significance Of Immunoparesis In Multiple Myeloma

Objective: Multiple myeloma(MM)is a hematological malignant originating from the B lymphocyte lineage.In MM patients,the level of one or more unaffected immunoglobulins is lower than normal,which is called immunoparesis.This study aims to analyze the characteristics and clinical significance of immunoparesis in MM patients.Methods: 160 MM patients who were firstly diagnosed in the Department of Hematology and Oncology in our hospital from November 1,2010 to September 30,2019 were used as research objects.We collected their clinical characteristics,results of laboratory and auxiliary examination and conducted a retrospective analysis.Results: The ratio of MM patients with immunoparesis was 93.8% at the first diagnosis.Patients with partial immunoparesis account for 80.0%.Patients with complete immunoparesis account for 13.8%,which were more common in Ig D and light chain MM.The ratio of MM patients with extremely severe immunoparesis was 43.1%. Compared with MM patients without immunoparesis,there was no statistically significant difference in gender,age,and the level of β2 microglobulin,creatinine,and lactate dehydrogenase of patients with immunoparesis at the first diagnosis(P>0.05).Patients with immunoparesis had a higher proportion of plasma cells in the bone marrow[28.0(37.0)vs 9.8(21.3)],higher level of monoclonal Ig A,Ig G[(37.5±25.9)g/l vs(13.2±0.8)g/l;(63.5±28.8)g/l vs(38.2±9.3)g/l],lower level of hemoglobin[76.0(33.8)g/l vs 94.5(34.0)g/l] and albumin[(29.3±7.9)g/l vs(34.8±3.9)g/l] at the time of initial diagnosis(P<0.05).The level of monoclonal Ig A and monoclonal Ig G was positively correlated with the degree of immunoparesis respectively(P=0.011<0.05,r=0.395;P=0.001<0.05,r=0.381).The D-S or ISS staging of MM patients was positively correlated with the degree of immunoparesis respectively(P=0.000<0.05,r=0.335;P=0.008<0.05,r=0.219).Infection in the first diagnosis of MM patients was not related with immunoparesis(P=0.514>0.05;P=0.512>0.05).The induction program containing immunomodulators was conducive to the improvement of immunoparesis(P=0.026<0.05).The efficacy of induction therapy in MM patients was positively correlated with the degree of improvement of immunoparesis(P=0.000<0.05,r=0.468).Conclusions: Immunoparesis is very common in MM patients.Patients with immunoparesis had a higher proportion of plasma cells in the bone marrow,higher level of monoclonal Ig A,Ig G,lower level of hemoglobin and albumin.Moreover,the degree of immunoparesis of MM patients increases with the increase of D-S or ISS staging,the level of monoclonal Ig A and monoclonal Ig G.Immunoparesis does not increase the risk of infection in MM patients.The induction therapy containing immunomodulators and effective induction therapy are beneficial to the improvement of immunoparesis.