title: Preserved levels of uninvolved immunoglobulins are independently associated with favorable outcome in patients with symptomatic multiple myeloma.
abstract: Suppression of uninvolved immunoglobulins is common in multiple myeloma (MM) but the prognostic significance of this phenomenon has not been assessed. We evaluated the prognostic significance of the preservation of uninvolved immunoglobulins in 1755 consecutive, unselected, patients with newly diagnosed, symptomatic MM with pre-therapy immunoglobulin levels measured by nephelometry. Suppression of at least one uninvolved immunoglobulin was observed in 87% of patients and was more common in patients with immunoglobulin A myeloma, those aged over 65 years, in patients with advanced-International Staging System (ISS) stage, extensive-bone marrow infiltration, anemia, low platelet counts, high levels of serum M-monoclonal protein or renal dysfunction. Patients with preserved immunoglobulins had a better survival than patients with suppressed immunoglobulins (median survival 55 vs 41.5 months, P<0.001). In multivariate analysis, preservation of uninvolved immunoglobulins was independently associated with better survival (hazard ratio: 0.781, 95% confidence interval: 0.618-0.987, P=0.039); irrespective of the treatment. In a subset of 500 patients, which were strictly followed for disease progression, preservation of uninvolved immunoglobulins was associated with a significantly longer progression-free survival (60 vs 25 months, P<0.001), independently of other common prognostic factors. In conclusion, preservation of uninvolved immunoglobulins in newly diagnosed patients with symptomatic MM was independently associated with long term disease control and improved survival.
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Kastritis
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: F
authors.initials: F
authors.lastname: Zagouri
authors.affiliation: Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Symeonidis
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Roussou
authors.affiliation: Department of Hematology, St Savvas Oncology Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Sioni
authors.affiliation: Department of Hematology, St Savvas Oncology Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Pouli
authors.affiliation: Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Delimpasi
authors.affiliation: Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Katodritou
authors.affiliation: Department of Hematology, 'Georgios Gennimatas' General Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Michalis
authors.affiliation: Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus.
authors.forename: M
authors.initials: M
authors.lastname: Michael
authors.affiliation: Department of Hematology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Hatzimichael
authors.affiliation: Department of Hematology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Vassou
authors.affiliation: Department of Hematology, Metaxa Cancer Hospital, Piraeus, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Repousis
authors.affiliation: Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Christophoridou
authors.affiliation: Department of Hematology, General Hospital of Chalkida, Chalkida, Greece.
authors.forename: Z
authors.initials: Z
authors.lastname: Kartasis
authors.affiliation: Department of Hematology, Amalia Fleming General Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Stefanoudaki
authors.affiliation: Department of Hematology, Metaxa Cancer Hospital, Piraeus, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Megalakaki
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Giannouli
authors.affiliation: Hematology Section and Laboratory, First Department of Propaedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M-C
authors.initials: MC
authors.lastname: Kyrtsonis
authors.affiliation: First Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Konstantopoulos
authors.affiliation: Immunology Labaratory, 'Alexandra' Hospital, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Spyroupoulou-Vlachou
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Terpos
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: M A
authors.initials: MA
authors.lastname: Dimopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002470:Cell Survival; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007136:Immunoglobulins / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology* / Q000628:therapy*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007136:Immunoglobulins