Immune dysregulation biomarkers associated with multiple myeloma change during treatment but retain their prognostic value over time, according to a study published in the American Journal of Hematology

A research team at the Mayo Clinic in Rochester, Minnesota, conducted a retrospective chart review to investigate changes in absolute lymphocyte (ALC) and absolute monocyte (AMC) counts at the start of treatment and at 1 month after treatment in patients who were newly diagnosed with multiple myeloma between January 2004 and December 2015. The outcome of interest was overall survival (OS).

ALC and AMC were assessed in 771 patients with a median age of 65 years (range, 27-90; male, 60%). The median patient follow-up time was 3.6 years (range, 0-13). At baseline, 31% (234/771) of patients had immune dysregulation, represented as abnormal biomarker counts. Of those patients, 37% (87/234) attained normal biomarker counts 1 month after treatment initiation (early immune reconstitution).

OS was higher in patients with no immune dysregulation at baseline (hazard ratio [HR] 0.77, 95% CI: 0.61-0.97, =.025) compared with patients who exhibited immune dysregulation. Similarly, patients with no immune dysregulation at 1 month (HR 0.63, 95% CI: 0.50-0.80, <.001) and those with early immune reconstitution (HR 0.62, 95% CI: 0.43-0.92, =.016) had higher OS compared with those who developed or had persistent immune dysregulation. 

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The authors concluded that future studies are needed “to elucidate the underlying mechanisms and answer [whether] this phenotype can be therapeutically induced in order to overcome the negative prognostic impact of immune dysregulation in patients with multiple myeloma.”

Reference

1. Binder M, Rajkumar SV, Lacy MQ, et al. Peripheral blood biomarkers of early immune reconstitution in newly diagnosed multiple myeloma [published on December 5, 2018]. Am J Hematol. doi: 10.1002/ajh.25365