Recommendations for Management of Secondary Antibody Deficiency in Multiple Myeloma

Authors

Sergio Giralt, Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Stephen Jolles, Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom.
Tessa Kerre, Department of Hematology, Ghent University Hospital, Ghent, Belgium.
Hillard M. Lazarus, Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, United States.
S Shahzad Mustafa, Rochester Regional HealthFollow
Genovefa A. Papanicolaou, Department of Medicine, Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Roberto Ria, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro Medical School, Bari, Italy.
Donald C. Vinh, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
John R. Wingard, Department of Medicine, Division of Hematology Oncology, University of Florida, Gainesville, FL, United States.

Department

Allergy and Immunology

Document Type

Article

Publication Title

Clinical Lymphoma, Myeloma & Leukemia

Abstract

Secondary antibody deficiency (SAD) is a subtype of secondary immunodeficiency characterized by low serum antibody concentrations (hypogammaglobulinemia) or poor antibody function. SAD is common in patients with multiple myeloma (MM) due to underlying disease pathophysiology and treatment-related immune system effects. Patients with SAD are more susceptible to infections and infection-related morbidity and mortality. With therapeutic advancements improving MM disease control and survival, it is increasingly important to recognize and treat the often-overlooked concurrent immunodeficiency present in patients with MM. The aims of this review are to define SAD and its consequences in MM, increase SAD awareness, and provide recommendations for SAD management. Based on expert panel discussions at a standalone meeting and supportive literature, several recommendations were made. Firstly, all patients with MM should be suspected to have SAD regardless of serum antibody concentrations. Patients should be evaluated for immunodeficiency at MM diagnosis and stratified into management categories based on their individualized risk of SAD and infection. Infection-prevention strategy education, early infection reporting, and anti-infective prophylaxis are key. We recommend prophylactic antibiotics or immunoglobulin replacement therapy (IgRT) should be considered in patients with severe hypogammaglobulinemia associated with a recurrent or persistent infection. To ensure an individualized and efficient treatment approach is utilized, patient's immunoglobin G concentration and infection burden should be closely monitored throughout treatment. Patient choice regarding route and IgRT treatment is also key in reducing treatment burden. Together, these recommendations and proposed management algorithms can be used to aid physician decision-making to improve patient outcomes.

First Page

719

Last Page

732

DOI

10.1016/j.clml.2023.05.008

Volume

23

Issue

10

Publication Date

10-1-2023

Medical Subject Headings

Humans; Multiple Myeloma (complications, diagnosis, therapy); Agammaglobulinemia (therapy); Immunologic Deficiency Syndromes (drug therapy); Immunization, Passive; Antibodies (therapeutic use)

PubMed ID

37353432

Recommended Citation

Giralt, S., Jolles, S., Kerre, T., Lazarus, H. M., Mustafa, S. S., Papanicolaou, G. A., Ria, R., Vinh, D. C., & Wingard, J. R. (2023). Recommendations for Management of Secondary Antibody Deficiency in Multiple Myeloma. Clinical Lymphoma, Myeloma & Leukemia, 23 (10), 719-732. https://doi.org/10.1016/j.clml.2023.05.008