HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients
Despite the outstanding progresses in Multiple Myeloma treatment options in the last decades, it remains an incurable disease nowadays. Infectious events are a complication due to an impaired immune system associated with MM, sometimes a life-threatening one, particularly on the first months after t...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-03-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.599532/full |
| _version_ | 1819141415993606144 |
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| author | Jose Luis Garcia de Veas Silva Maria Trinidad Gonzalez Cejudo Alberto Garcia Perojil Jimenez Maria del Señor Garcia Lopez Velez Rafael Garcia Rios Tamayo Carmen Garcia Bermudo Guitarte Tomas Garcia De Haro Muñoz |
| author_facet | Jose Luis Garcia de Veas Silva Maria Trinidad Gonzalez Cejudo Alberto Garcia Perojil Jimenez Maria del Señor Garcia Lopez Velez Rafael Garcia Rios Tamayo Carmen Garcia Bermudo Guitarte Tomas Garcia De Haro Muñoz |
| author_sort | Jose Luis Garcia de Veas Silva |
| collection | DOAJ |
| description | Despite the outstanding progresses in Multiple Myeloma treatment options in the last decades, it remains an incurable disease nowadays. Infectious events are a complication due to an impaired immune system associated with MM, sometimes a life-threatening one, particularly on the first months after the diagnosis. Both the underlying disease and treatment can contribute to the infection risk, so a biomarker that assess this risk could be highly relevant for a more tailored management of the patient. The measurement of the heavy+light chain (HLC) pairs of immunoglobulins in serum allows the quantification of both the monoclonal component and the non-monoclonal immunoglobulin of the same isotype. This approach has demonstrated high sensitivity for the detection of the clonality and prognostic value for MM. HLC pair suppression itself has prognostic power and it has been proposed to be a reflection of the immune system’ attempt to control the tumor. In this study we evaluated the impact of the HLC pair suppression on the rate of bloodstream infections (BSI) and early death in 115 newly diagnosed MM patients. Twenty-one percent of the patients suffered a BSI in the first 6 months after diagnosis, of which 58% died within this period, accounting to 67% of the early deaths in global and highlighting the major impact of infections on MM patients in a “real world” setting. Severe HLC pair suppression identified patients with a higher risk of early BSI (HR: 6,97, p=0,009), and extreme HLC pair suppression together with BSI event and age >65 were independent risk factors for early death (p<0,001). Based on these factors, a stratification model was generated to allow identify patients at a higher risk of early death and poorer OS, with an apparently better performance than the ISS on the early death context. In conclusion, HLC pair suppression associates with both a higher risk of life-threatening early infection and early death in newly diagnosed MM patients. Patients older than 65 with extreme HLC pair suppression and BSI are at a high risk of early death, and thus patients presenting with these criteria have a very adverse prognosis. |
| first_indexed | 2024-12-22T11:54:06Z |
| format | Article |
| id | doaj.art-2b2d13b1588a49eba7b90cdf965fdca9 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-22T11:54:06Z |
| publishDate | 2021-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2b2d13b1588a49eba7b90cdf965fdca92022-12-21T18:26:53ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-03-011110.3389/fonc.2021.599532599532HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma PatientsJose Luis Garcia de Veas Silva0Maria Trinidad Gonzalez Cejudo1Alberto Garcia Perojil Jimenez2Maria del Señor Garcia Lopez Velez3Rafael Garcia Rios Tamayo4Carmen Garcia Bermudo Guitarte5Tomas Garcia De Haro Muñoz6Department of Laboratory Medicine, Hospital Universitario San Cecilio, Granada, SpainDepartment of Laboratory Medicine, Hospital Universitario San Cecilio, Granada, SpainDepartment of Laboratory Medicine, Hospital Universitario San Cecilio, Granada, SpainDepartment of Laboratory Medicine, Hospital Universitario San Cecilio, Granada, SpainDepartment of Hematology, Hospital Universitario Virgen de las Nieves, Granada, SpainDepartment of Clinical Biochemistry, Hospital Universitario Virgen Macarena, Seville, SpainDepartment of Laboratory Medicine, Hospital Universitario San Cecilio, Granada, SpainDespite the outstanding progresses in Multiple Myeloma treatment options in the last decades, it remains an incurable disease nowadays. Infectious events are a complication due to an impaired immune system associated with MM, sometimes a life-threatening one, particularly on the first months after the diagnosis. Both the underlying disease and treatment can contribute to the infection risk, so a biomarker that assess this risk could be highly relevant for a more tailored management of the patient. The measurement of the heavy+light chain (HLC) pairs of immunoglobulins in serum allows the quantification of both the monoclonal component and the non-monoclonal immunoglobulin of the same isotype. This approach has demonstrated high sensitivity for the detection of the clonality and prognostic value for MM. HLC pair suppression itself has prognostic power and it has been proposed to be a reflection of the immune system’ attempt to control the tumor. In this study we evaluated the impact of the HLC pair suppression on the rate of bloodstream infections (BSI) and early death in 115 newly diagnosed MM patients. Twenty-one percent of the patients suffered a BSI in the first 6 months after diagnosis, of which 58% died within this period, accounting to 67% of the early deaths in global and highlighting the major impact of infections on MM patients in a “real world” setting. Severe HLC pair suppression identified patients with a higher risk of early BSI (HR: 6,97, p=0,009), and extreme HLC pair suppression together with BSI event and age >65 were independent risk factors for early death (p<0,001). Based on these factors, a stratification model was generated to allow identify patients at a higher risk of early death and poorer OS, with an apparently better performance than the ISS on the early death context. In conclusion, HLC pair suppression associates with both a higher risk of life-threatening early infection and early death in newly diagnosed MM patients. Patients older than 65 with extreme HLC pair suppression and BSI are at a high risk of early death, and thus patients presenting with these criteria have a very adverse prognosis.https://www.frontiersin.org/articles/10.3389/fonc.2021.599532/fullmyelomaprognostic factorHLC (heavy/light chain)infectionimmunoparesis |
| spellingShingle | Jose Luis Garcia de Veas Silva Maria Trinidad Gonzalez Cejudo Alberto Garcia Perojil Jimenez Maria del Señor Garcia Lopez Velez Rafael Garcia Rios Tamayo Carmen Garcia Bermudo Guitarte Tomas Garcia De Haro Muñoz HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients Frontiers in Oncology myeloma prognostic factor HLC (heavy/light chain) infection immunoparesis |
| title | HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients |
| title_full | HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients |
| title_fullStr | HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients |
| title_full_unstemmed | HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients |
| title_short | HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients |
| title_sort | hlc pair suppression as a risk factor for bacterial bloodstream infections and early mortality in newly diagnosed intact immunoglobulin multiple myeloma patients |
| topic | myeloma prognostic factor HLC (heavy/light chain) infection immunoparesis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.599532/full |
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