Characterisation and prognostic impact of immunoparesis in relapsed multiple myeloma (MM) is lacking in the current literature. We evaluated 258 patients with relapsed MM, diagnosed from 2008 to 2015, to investigate the prognostic impact of deep immunoparesis on post‐relapse survival. On qualitative immunoparesis assessment, no, partial and full immunoparesis was present in 9%, 30% and 61% of patients, respectively. Quantitative immunoparesis was assessed by computing the average relative difference (ARD) between polyclonal immunoglobulin(s) and corresponding lower normal limit(s), with greater negative values indicating deeper immunoparesis. The median ARD was −39%, with an optimal cut‐off of −50% for overall survival (OS) by recursive partitioning analysis. Deep immunoparesis (ARD ≤–50%) was associated with a higher tumour burden at first relapse compared to none/shallow [ARD >−50%] immunoparesis. The OS (P  = 0·007) and progression‐free survival (PFS; P  < 0·001) differed significantly between the deep and none/shallow immunoparesis groups. Kaplan–Meier estimates for 3‐year OS were 36% and 46%, and for 2‐year PFS were 17% and 27%, respectively. On multivariable analysis (MVA) for PFS, both qualitative and quantitative immunoparesis retained negative prognostic impact independently. However, only quantitative immunoparesis was independently prognostic for OS on MVA. Depth of immunoparesis in relapsed MM is an important prognostic factor for post‐relapse survival in the era of novel agents and continuous therapy.

中文翻译：

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复发性多发性骨髓瘤中免疫麻痹的特征和预后影响。

目前的文献中缺乏免疫麻痹对复发性多发性骨髓瘤 (MM) 的表征和预后影响。我们评估了 2008 年至 2015 年诊断的 258 名复发性 MM 患者，以研究深度免疫麻痹对复发后生存期的预后影响。在定性免疫麻痹评估中，分别有 9%、30% 和 61% 的患者出现无、部分和完全免疫麻痹。通过计算多克隆免疫球蛋白和相应的正常下限之间的平均相对差异 (ARD) 来评估定量免疫麻痹，负值越大表明免疫麻痹越深。通过递归分区分析，中位 ARD 为 -39%，总生存期 (OS) 的最佳截止值为 -50%。与无/浅 [ARD >-50%] 免疫麻痹相比，深度免疫麻痹 (ARD ≤–50%) 与首次复发时较高的肿瘤负荷相关。操作系统（P  = 0·007）和无进展生存期（PFS；P  < 0·001）在深度和无/浅度免疫麻痹组之间存在显着差异。Kaplan-Meier 估计 3 年 OS 为 36% 和 46%，2 年 PFS 分别为 17% 和 27%。在 PFS 的多变量分析 (MVA) 中，定性和定量免疫麻痹均独立保留了负面预后影响。然而，只有定量免疫麻痹对 MVA 上的 OS 具有独立的预后作用。在新药和持续治疗的时代，复发性 MM 的免疫麻痹深度是复发后生存的重要预后因素。