Immunoparesis remains a negative prognostic factor in newly diagnosed Multiple Myeloma by competing risk analysis

Background Recent reports describe worst outcome in patients with multiple myeloma (MM) and immunoparesis (IP). However, infections can be considered a competing event when analyzing the impact of IP on overall survival (OS). Here, we analyzed the prognostic impact of IP in newly diagnosed MM (NDMM) with a different approach. Methods This is a single-center retrospective study of NDMM patients diagnosed between 2000 to 2018. We defined IP as suppression of both uninvolved polyclonal immunoglobulins in IgG and IgA MM or three uninvolved polyclonal immunoglobulins in light-chain MM. Results A total of 651 patients with NDMM were diagnosed and treated at our institution. Median age at diagnosis was 65 years old (56 – 74). The M-protein isotype was IgG in 355 (55%) patients, IgA in 184 (28%), light – chain in 98 (15%) and IgD in 14 (2%). At diagnosis, IP was present in 318 (47%) patients, and increased with each ISS stage (37% in ISS-1, 54% in ISS-2 and 63% in ISS-3; p Conclusion In patients with NDMM, IP is an important negative biomarker with shorter median PFS. Its prognostic impact was similar to other known potent risk factors of progression. Regarding OS, IP kept its negative impact even in the presence of severe infections deaths as competing events.