Prognostic Relevance of Multi-Antigenic Myeloma-Specific T-Cell Assay in Patients with Monoclonal Gammopathies

Abstract

Multiple Myeloma (MM) typically originates from underlying precursor conditions, known as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM). Validated risk factors, related to the main features of the clonal plasma cells, are employed in the current prognostic models to assess long-term probabilities of progression to MM. In addition, new prognostic immunologic parameters, measuring protective MM-specific T-cell responses, could help to identify patients with shorter time-to-progression. In this report, we described a novel Multi-antigenic Myeloma-specific (MaMs) T-cell assay, based on ELISpot technology, providing simultaneous evaluation of T-cell responses towards ten different MM-associated antigens. When performed during long-term follow-up (mean 28 months) of 33 patients with either MGUS or SMM, such deca-antigenic myeloma-specific immunoassay allowed to significantly distinguish between stable vs. progressive disease (p < 0.001), independently from the Mayo Clinic risk category. Here, we report the first clinical experience showing that a wide (multi-antigen), standardized (irrespective to patients’ HLA), MM-specific T-cell assay may routinely be applied, as a promising prognostic tool, during the follow-up of MGUS/SMM patients. Larger studies are needed to improve the antigenic panel and further explore the prognostic value of MaMs test in the risk assessment of patients with monoclonal gammopathies.

SARS‐CoV‐2 infection is not associated with the emergence of monoclonal gammopathies

“…For this reason, SPEP in patients with MC during a period of active infection requires monitoring to ascertain whether the observed MC is temporary. Moreover, it has been demonstrated that the immune system can control the proliferation of clonal plasma cells, suggesting that a protective T‐cell immunity could be important to prevent the transition from MGUS to MM 19,20 …”

“…Moreover, it has been demonstrated that the immune system can control the proliferation of clonal plasma cells, suggesting that a protective T-cell immunity could be important to prevent the transition from MGUS to MM. 19,20 In severe COVID-19 a massive innate and adaptive immune response (the so-called cytokine storm) is often observed. The humoral immune response against SARS-CoV-2 has been confirmed by the presence of monoclonal IgG, IgA, and IgM in the days following infection in the serum of COVID-19 patients.…”