Article open access publication

Immunoparesis in newly diagnosed Multiple Myeloma patients: Effects on overall survival and progression free survival in the Danish population

PLoS ONE, Public Library of Science (PLoS), ISSN 1932-6203

Volume 12, 12, 2017

DOI:10.1371/journal.pone.0188988, Dimensions: pub.1099617499, PMC: PMC5720701, PMID: 29216227,



  1. (1) University of Copenhagen, grid.5254.6, KU
  2. (2) Rigshospitalet, grid.475435.4, Capital Region
  3. (3) Herlev Hospital, grid.411900.d, Capital Region
  4. (4) Zealand University Hospital, grid.476266.7, Zealand Region
  5. (5) Vejle Sygehus, grid.417271.6, Southern Denmark Region
  6. (6) Aarhus University Hospital, grid.154185.c, Central Denmark Region
  7. (7) Regional Hospital Holstebro, grid.414304.6, Central Denmark Region
  8. (8) Hospital of South West Jutland, grid.414576.5, Southern Denmark Region
  9. (9) Aalborg Hospital, grid.27530.33, North Denmark Region
  10. (10) Odense University Hospital, grid.7143.1, Southern Denmark Region






Immunoparesis (hypogammaglobulinemia) is associated to an unfavorable prognosis in newly diagnosed Multiple myeloma (MM) patients. However, this finding has not been validated in an unselected population-based cohort. We analyzed 2558 newly diagnosed MM patients in the Danish Multiple Myeloma Registry representing the entire MM population in Denmark from 2005-2013. Two-thousand two hundred and fifty three patients (90%) presented with reduction below lower normal levels of at least one uninvolved immunoglobulin. Using multivariable Cox regression we found that high age, high ISS score, high LDH and IgA MM were associated to both shorter overall survival and progression free survival. Furthermore, bone marrow plasma cell % was associated to short progression free survival. Immunoparesis had no independent significant effect on OS (HR 0.9 (95%CI: 0.7;1.0; p = 0.12)). Likewise, the number of suppressed immunoglobulins or the relative degree of suppressed uninvolved immunoglobulins from lower normal level (quantitative immunoparesis) was not associated to OS in the multivariable analysis. However, quantitative immunoparesis with at least 25% reduction (from lower normal level) of uninvolved immunoglobulins was associated to shorter PFS for the entire population. The impact of quantitative immunoparesis on PFS was present irrespective of calendar periods 2005-2008 and 2009-2013. Our population-based study does not confirm that immunoparesis at diagnosis is an independent prognostic factor regarding OS. However, quantitative immunoparesis is associated to a shorter PFS.

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