Secondary Immunodeficiency and Hypogammaglobulinemia with IgG Levels of <5 g/L in Patients with Multiple Myeloma: A Retrospective Study Between 2012 and 2020 at a University Hospital in China

Abstract

Background Infections are the main cause of mortality and morbidity in multiple myeloma (MM) patients. However, adult immunodeficiency specialists in China are lacking, and the care of secondary immunodeficiency (SID) and the prognostic role of hypogammaglobulinemia in MM is unknown. Material/Methods MM patients (295) were retrospectively analyzed between January 2012 and 2020 in Zhejiang Provincial People’s Hospital, Hangzhou Medical College. MM patients with immunoglobulin (Ig) G <5 g/L were defined as SID patients. The care of these patients and the prognostic role of IgG <5 g/L were analyzed. Results Forty-five of 295 MM patients with IgG <5 g/L were defined as SID patients. These 45 patients mainly had recurrent infections, especially pulmonary bacterial infections; 2 patients had them 5 times/year. The median survival time was significantly shorter in MM patients with SID (24 vs 66 months). More importantly, the multivariate and univariate analysis revealed that IgG <5 g/L was an independent prognostic factor for MM patients. Conclusions Ig replacement therapy or prophylactic antibiotics for MM patients with SID were lacking in this single retrospective study. IgG <5 g/L could be a prognostic marker for MM patients.

Access and use of immunoglobulins in secondary supportive cancer care: A systematic literature review

“…A total of 43 articles relevant to the topic of IgRT in HMs were identified within the period of 2012-2022. Of these articles, 4 were qualitative studies, 12,27-29 10 were narrative literature syntheses which featured expert opinions, 17,[30][31][32][33][34][35][36][37][38] 1 was a systematic review, 39 15 were retrospective casecontrolled cohort studies, [40][41][42][43][44][45][46][47][48][49][50][51][52][53]67 1 was a non-randomised control trial, 54 1 was a mixed-methods cohort study, 55 4 were case reports, [56][57][58][59] 6 were prospective case-controlled studies [60][61][62][63][64][65] and 1 was a randomised placebo-controlled trial 66 (Figure 2). On first glance, it could be argued that these data demonstrate a lack of rigour in the studies conducted; however, in reality, the study of medicine use and access is often best investigated using cohort studies as they provide a realistic source of data and are more costeffective and cause less disruption to healthcare provision than randomised control trials.…”

“…Hence, now is the time to invest resources into addressing the topic of immunoglobulin use, so that patients can continue to access IgRT as a supportive cancer treatment in HM. Geographical location: China (n = 2), 27,46 France (n = 3), 34,48,64 Oceania -Australia/New Zealand (n = 2), 29,40 United States (n = 7), 43,45,[52][53][54]58,63 Italy (n = 7), 33,41,47,49,50,66,67 Sweden (n = 1), 55 Japan (n = 1), 56 Spain (n = 2), 35,42 United Kingdom (n = 2), 44,61 Germany (n = 2), 60,62 Belgium (n = 1), 37 Greece (n = 1) 51 and India (n = 1). 65…”

The potential link between Covid‐19 and multiple myeloma: A new saga

“…Moreover, hyper/hypogammaglobulinemia, hypercalcemia, and amyloidosis are the most common causes of the development of renal insufficiency in MM 18 . Also, immune deficiency in MM increases the risk for secondary bacterial infections 19 …”

Secondary Immunodeficiency in Hematological Malignancies: Focus on Multiple Myeloma and Chronic Lymphocytic Leukemia

“…The median survival time was considerably shorter in MM subjects with SID (24 vs 66 months). More importantly, the multivariate and univariate analysis revealed that IgG <5 g/L was an independent prognostic factor for MM patients ( 80 ).…”