TY - JOUR
T1 - Immunoparesis in newly diagnosed Multiple Myeloma patients
T2 - Effects on overall survival and progression free survival in the Danish population
AU - Sørrig, Rasmus
AU - Klausen, Tobias W
AU - Salomo, Morten
AU - Vangsted, Annette J
AU - Frølund, Ulf Christian
AU - Andersen, Kristian T
AU - Klostergaard, Anja
AU - Helleberg, Carsten
AU - Pedersen, Robert S
AU - Pedersen, Per T
AU - Helm-Petersen, Sissel
AU - Teodorescu, Elena Manuela
AU - Preiss, Birgitte
AU - Abildgaard, Niels
AU - Gimsing, Peter
AU - Danish Myeloma Study Group
A2 - Svirskaite, Asta
A2 - Teodorescu, Elena Manuela
A2 - Johnsen, Hans Erik
A2 - Gregersen, Henrik
A2 - Gade, Inger Lise
A2 - Bødker, Julie Støve
PY - 2017
Y1 - 2017
N2 - Immunoparesis (hypogammaglobulinemia) is associated to an unfavorable prognosis in newly diagnosed Multiple myeloma (MM) patients. However, this finding has not been validated in an unselected population-based cohort. We analyzed 2558 newly diagnosed MM patients in the Danish Multiple Myeloma Registry representing the entire MM population in Denmark from 2005-2013. Two-thousand two hundred and fifty three patients (90%) presented with reduction below lower normal levels of at least one uninvolved immunoglobulin. Using multivariable Cox regression we found that high age, high ISS score, high LDH and IgA MM were associated to both shorter overall survival and progression free survival. Furthermore, bone marrow plasma cell % was associated to short progression free survival. Immunoparesis had no independent significant effect on OS (HR 0.9 (95%CI: 0.7;1.0; p = 0.12)). Likewise, the number of suppressed immunoglobulins or the relative degree of suppressed uninvolved immunoglobulins from lower normal level (quantitative immunoparesis) was not associated to OS in the multivariable analysis. However, quantitative immunoparesis with at least 25% reduction (from lower normal level) of uninvolved immunoglobulins was associated to shorter PFS for the entire population. The impact of quantitative immunoparesis on PFS was present irrespective of calendar periods 2005-2008 and 2009-2013. Our population-based study does not confirm that immunoparesis at diagnosis is an independent prognostic factor regarding OS. However, quantitative immunoparesis is associated to a shorter PFS.
AB - Immunoparesis (hypogammaglobulinemia) is associated to an unfavorable prognosis in newly diagnosed Multiple myeloma (MM) patients. However, this finding has not been validated in an unselected population-based cohort. We analyzed 2558 newly diagnosed MM patients in the Danish Multiple Myeloma Registry representing the entire MM population in Denmark from 2005-2013. Two-thousand two hundred and fifty three patients (90%) presented with reduction below lower normal levels of at least one uninvolved immunoglobulin. Using multivariable Cox regression we found that high age, high ISS score, high LDH and IgA MM were associated to both shorter overall survival and progression free survival. Furthermore, bone marrow plasma cell % was associated to short progression free survival. Immunoparesis had no independent significant effect on OS (HR 0.9 (95%CI: 0.7;1.0; p = 0.12)). Likewise, the number of suppressed immunoglobulins or the relative degree of suppressed uninvolved immunoglobulins from lower normal level (quantitative immunoparesis) was not associated to OS in the multivariable analysis. However, quantitative immunoparesis with at least 25% reduction (from lower normal level) of uninvolved immunoglobulins was associated to shorter PFS for the entire population. The impact of quantitative immunoparesis on PFS was present irrespective of calendar periods 2005-2008 and 2009-2013. Our population-based study does not confirm that immunoparesis at diagnosis is an independent prognostic factor regarding OS. However, quantitative immunoparesis is associated to a shorter PFS.
KW - Journal Article
UR - http://www.scopus.com/inward/record.url?scp=85037606674&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0188988
DO - 10.1371/journal.pone.0188988
M3 - Journal article
C2 - 29216227
SN - 1932-6203
VL - 12
JO - PLOS ONE
JF - PLOS ONE
IS - 12
M1 - e0188988
ER -