title: Recovery of polyclonal immunoglobulins one year after autologous stem cell transplantation as a long-term predictor marker of progression and survival in multiple myeloma.
abstract: Immunoparesis or suppression of polyclonal immunoglobulins is a very common condition in newly diagnosed myeloma patients. However, the recovery of polyclonal immunoglobulins in the setting of immune reconstitution after autologous stem cell transplantation and its effect on outcome has not yet been explored. We conducted this study in a cohort of 295 patients who had undergone autologous transplantation. In order to explore the potential role of immunoglubulin recovery as a dynamic predictor of progression or survival after transplantation, conditional probabilities of progression-free survival and overall survival were estimated according to immunoglobulin recovery at different time points using a landmark approach. One year after transplant, when B-cell reconstitution is expected to be completed, among 169 patients alive and progression free, 88 patients (52%) showed immunoglobulin recovery and 81 (48%) did not. Interestingly, the group with immunoglobulin recovery had a significantly longer median progression-free survival than the group with persistent immunoparesis (median 60.4vs.27.9 months, respectively; Hazard Ratio: 0.45, 95%Confidence Interval: 0.31-0.66;P<0.001), and improved overall survival (11.3 vs. 7.3 years; Hazard Ratio: 0.45, 95%Confidence Interval: 0.27-0.74;P=0.002). Furthermore, the percentage of normal plasma cells detected by flow cytometry in the bone marrow assessed at day 100 after transplantation was associated with the immunoglobulin recovery at that time and may predict immunoglobulin recovery in the subsequent months: nine months and one year. In conclusion, the recovery of polyclonal immunoglobulins one year after autologous transplantation in myeloma patients is an independent long-term predictor marker for progression and survival.
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: González-Calle
authors.affiliation: Complejo Asistencial de León, Spain.
authors.forename: Seila
authors.initials: S
authors.lastname: Cerdá
authors.affiliation: Complejo Asistencial de Burgos, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Labrador
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sobejano
authors.affiliation: Hospital Nuestra Señora de Sonsoles de Ávila, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González-Mena
authors.affiliation: Hospital Del Bierzo Ponferrada, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Aguilera
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Enrique María
authors.initials: EM
authors.lastname: Ocio
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: María Belén
authors.initials: MB
authors.lastname: Vidriales
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Puig
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Norma Carmen
authors.initials: NC
authors.lastname: Gutiérrez
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: García-Sanz
authors.affiliation: Hospital Río Carrión de Palencia, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Alonso
authors.affiliation: Hospital Virgen del Puerto de Plasencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: López
authors.affiliation: Complejo Asistencial de Soria, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguilar
authors.affiliation: Hospital Clínico de Valladolid, Spain.
authors.forename: Alfonso García
authors.initials: AG
authors.lastname: de Coca
authors.affiliation: Complejo Asistencial de Zamora, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernández
authors.affiliation: Complejo Asistencial de Segovia, Spain.
authors.forename: José Mariano
authors.initials: JM
authors.lastname: Hernández
authors.affiliation: Complejo Asistencial de León, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Escalante
authors.affiliation: Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Spain mvmateos@usal.es.
authors.forename: María-Victoria
authors.initials: MV
authors.lastname: Mateos
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007136:Immunoglobulins / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D014408:Biomarkers, Tumor; D007136:Immunoglobulins