Immunoparesis in symptomatic multiple myeloma at diagnosis affects PFS with bortezomib-containing induction therapy, but not ASCT consolidation.

In novel agent era, the impact of immunoparesis at diagnosis on outcomes in symptomatic multiple myeloma (MM) remains unclear. We reviewed medical records of 147 MM patients at Beijing Chao Yang hospital. Most patients exhibited immunoparesis at diagnosis (84%). After a median follow-up of 27 months (range 1-78 months), in the group with immunoparesis at diagnosis, there was a very significantly shorter progression-free survival (PFS) than in the group without immunoparesis (estimated PFS of not reached vs 25 months, P = 0.001). Patients with suppressed Immunoglobulins (Igs) had the tendency to have a shorter OS than patients without suppression (estimated OS of not reached vs 38 months, P = 0.06). In multivariate analysis, the negative impact of immunoparesis on PFS was confirmed. In addition, achievement of both at least VGPR and at least CR was significantly higher in patients with preserved uninvolved Igs than in those with suppression of at least one uninvolved Ig. However, the negative impact of immunoparesis on response was not confirmed in a multivariate analysis. These results suggest immunoparesis in patients with symptomatic MM at diagnosis is an independent poor prognostic factor for upfront bortezomib-containing regimen.