Research status of immunoparesis in multiple myeloma

doi:10.12092/j.issn.1009-2501.2026.04.016

Abstract

Abstract:

Multiple myeloma (MM) is associated with a high rate of disease recurrence, and one of the reasons for disease progression is changes in the tumor microenvironment and immune cell dysfunction, which leads to the loss of tumor-specific immunity. Immunoparesis is a common phenomenon in MM patients and is characterized by suppression of one or more uninvolved polyclonal immunoglobulins. In monoclonal gammopathy of undetermined significance and smoldering multiple myeloma, the presence of immunoparesis is considered to be one of the risk factors for progression to symptomatic MM. The increased risk of infection in MM patients has also been associated with immunoparesis. In recent years, the prognostic value of immunoparesis in patients with first diagnosis of MM has been reported, but whether it is a good prognostic indicator remains controversial. Understanding the pathophysiological mechanisms of immunoparesis in MM patients, the impact on the disease, and management is crucial to provide a direction for MM prognostic research.

Key words: multiple myeloma, immunoparesis, prognosis, infection

CLC Number:

R553

Qianmin ZENG, Jiejun ZHAO, Yaming XI. Research status of immunoparesis in multiple myeloma[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(4): 561-567.

Figures/Tables 2

References 43

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Author	Number of patients	Immunoparesis(%)	Prognostic significance of immunoparesis
Sorrig et al^[5]	2558 NDMM patients	2253(90%)	IP had no independent significant effect on OS (P = 0.12; HR 0.9 [0.7-1.0]). Qualitative IP was near significant riskfactor for PFS (P=0.054；HR 1.2[1.0-1.4]) and either 25%, 50% or 75% reduction in uninvolved immunoglobulin levels was all independent effect on PFS
Lakhwani et al^[29]	113 newly diagnosed transplant-ineligible patients	104(92%)	Patients who had IP at diagnosis and recovered it during or after treatment had longer OS ( P=0.007; HR 0.40[0.20-0.80]) and PFS (P<0.001;HR 0.32[0.19-0.52])
Chen et al^[4]	142 patients with MM	125(88%)	Severe and continuous IP ( at least two uninvolved Igs were suppressed continuously) was independent effect on OS (P=0.017; HR 1.275[1.044-1.556]) and PFS (P<0.001; HR 1.449[1.233-1.702])
Geng et al^[28]	287 NDMM patients	265(92.3%) 70% severe IP 80.8% partial IP	Severe (one of uninvolved immunoglobulins was below 50% the lower limit of normal ranges) and partial IP (suppression of at least two uninvolved immunoglobulins) were independently associated with shorter OS (P=0.040; HR 1.7[1.0-2.8]) and PFS (P=0.037; HR 1.7[1.0-2.9])
Lei et al^[6]	93 patients with MM who underwent ASCT	-	Patients who recovered from IP within 12 months after ASCT had longer OS (P<0.001) and PFS (P= 0.001)
Davila et al^[27]	431 transplant-ineligible patients with MM	350(81.2%)	IP was associated with a shorter OS (P=0.057; HR 0.746[0.551-1.010]) and PFS (P=0.066; HR 0.775[0.590-1.018]). Patients recovering from IP had longer OS (P=0.011; HR 0.678 [0.503-0.913]) and PFS (P=0.018; HR 0.703[0.526-0.941])

Author	Number of patients	Immunoparesis(%)	Prognostic significance of immunoparesis
Sorrig et al^[5]	2558 NDMM patients	2253(90%)	IP had no independent significant effect on OS (P = 0.12; HR 0.9 [0.7-1.0]). Qualitative IP was near significant riskfactor for PFS (P=0.054；HR 1.2[1.0-1.4]) and either 25%, 50% or 75% reduction in uninvolved immunoglobulin levels was all independent effect on PFS
Lakhwani et al^[29]	113 newly diagnosed transplant-ineligible patients	104(92%)	Patients who had IP at diagnosis and recovered it during or after treatment had longer OS ( P=0.007; HR 0.40[0.20-0.80]) and PFS (P<0.001;HR 0.32[0.19-0.52])
Chen et al^[4]	142 patients with MM	125(88%)	Severe and continuous IP ( at least two uninvolved Igs were suppressed continuously) was independent effect on OS (P=0.017; HR 1.275[1.044-1.556]) and PFS (P<0.001; HR 1.449[1.233-1.702])
Geng et al^[28]	287 NDMM patients	265(92.3%) 70% severe IP 80.8% partial IP	Severe (one of uninvolved immunoglobulins was below 50% the lower limit of normal ranges) and partial IP (suppression of at least two uninvolved immunoglobulins) were independently associated with shorter OS (P=0.040; HR 1.7[1.0-2.8]) and PFS (P=0.037; HR 1.7[1.0-2.9])
Lei et al^[6]	93 patients with MM who underwent ASCT	-	Patients who recovered from IP within 12 months after ASCT had longer OS (P<0.001) and PFS (P= 0.001)
Davila et al^[27]	431 transplant-ineligible patients with MM	350(81.2%)	IP was associated with a shorter OS (P=0.057; HR 0.746[0.551-1.010]) and PFS (P=0.066; HR 0.775[0.590-1.018]). Patients recovering from IP had longer OS (P=0.011; HR 0.678 [0.503-0.913]) and PFS (P=0.018; HR 0.703[0.526-0.941])

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