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Published on: November 26, 2018
Polyclonal serum IgM level identifies a subgroup of multiple myeloma patients with low-risk clinicobiological
Gang An1, Huijun Wang1, Xiaoqi Qin1
1State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, People's Republic of China.
Abstract:
Normal plasma cells (PCs) are either undetectable or outnumbered by the myelomatous PC compartment in bone marrow of multiple myeloma (MM). However, residual normal PCs have been detected in a minority of symptomatic MM patients with superior survival. The number of normal PCs is also an important factor to identify monoclonal gammopathy of undetermined significance (MGUS)-like MM. We speculate that the polyclonal serum IgM level in non-IgM myelomas may reflect the number of residual normal PCs. Here we investigated the prognostic relevance of polyclonal serum IgM level in a series of 485 newly diagnosed symptomatic MM (NDMM) patients. Our results showed that symptomatic MM patients with polyclonal IgM more than 0.5g/L displayed a favorable baseline clinical feature, together with a significantly lower frequency of high-risk cytogenetic abnormalities. This group of patients had a significantly prolonged progression-free survival (PFS) and overall survival (OS) regardless of thalidomide or bortezomib therapy. Furthermore, the superior outcome was independent of the depth of response. Our findings suggest that polyclonal IgM level is capable of identifying a group of symptomatic MM patients with distinct clinicobiological characteristics and favorable survival, similar with MGUS-like MM.
Insights
Elevated polyclonal IgM levels in newly diagnosed multiple myeloma (MM) patients indicate a favorable prognosis. This biomarker identifies patients with better survival outcomes, irrespective of treatment or response depth.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Normal plasma cells (PCs) are typically outnumbered by myeloma cells in multiple myeloma (MM).
- Residual normal PCs in some MM patients correlate with superior survival and identify MGUS-like MM.
- Polyclonal serum IgM levels may serve as a surrogate marker for normal PC numbers in non-IgM myelomas.
Purpose of the Study:
- To investigate the prognostic significance of polyclonal serum IgM levels in newly diagnosed symptomatic multiple myeloma (NDMM) patients.
- To determine if polyclonal IgM levels can identify a subgroup of MM patients with favorable clinical characteristics and outcomes.
Main Methods:
- Analysis of polyclonal serum IgM levels in 485 newly diagnosed symptomatic MM patients.
- Correlation of IgM levels with baseline clinical features, cytogenetic abnormalities, and survival outcomes (PFS and OS).
- Evaluation of prognostic relevance independent of therapy (thalidomide, bortezomib) and response depth.
Main Results:
- MM patients with polyclonal IgM > 0.5 g/L exhibited favorable baseline clinical features.
- This group had a significantly lower frequency of high-risk cytogenetic abnormalities.
- Patients with higher polyclonal IgM levels demonstrated significantly prolonged progression-free survival (PFS) and overall survival (OS).
- The favorable outcome was independent of treatment and response depth.
Conclusions:
- Polyclonal serum IgM level is a valuable prognostic marker in symptomatic MM.
- Elevated polyclonal IgM identifies a distinct subgroup of MM patients with favorable clinicobiological characteristics and superior survival.
- This finding suggests potential parallels with MGUS-like MM.
