What is it about?
Multiple myeloma is characterised by the expansion of malignant plasma cells and production of a monoclonal immunoglobulin, but the resulting immune dysfunction extends far beyond the M-protein. This narrative review examines immunoparesis as a broader state of immune impairment in multiple myeloma, encompassing suppression of polyclonal immunoglobulins and wider disturbances in humoral and cellular immunity. We discuss how immunoparesis contributes to infection susceptibility and how this risk is influenced by disease- and treatment-related factors.
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Why is it important?
Infections remain an important cause of morbidity and mortality in patients with multiple myeloma. The increasing use of highly effective immune-directed therapies, including monoclonal antibodies, antibody-drug conjugates, bispecific antibodies and CAR T-cell therapy, has further highlighted the clinical consequences of treatment-associated immune dysfunction. Recognising immunoparesis and understanding its broader effects may help identify patients at increased risk of infection and inform strategies for prevention and management, including antimicrobial prophylaxis, immunoglobulin replacement and vaccination.
Perspectives
The clinical significance of immunoparesis extends beyond the measurement of the monoclonal protein or total immunoglobulin concentration. A more comprehensive assessment of immune competence may be needed to identify patients who remain vulnerable to infection despite effective control of their myeloma. As treatment continues to move towards increasingly potent immune-directed approaches, integrating assessment of immune dysfunction with disease response could become an important component of personalised supportive care. Further research is needed to define clinically useful biomarkers of immune competence and to determine which patients are most likely to benefit from interventions such as immunoglobulin replacement and targeted infection prophylaxis.
Dr Catherine Worsley
University of Pretoria
Read the Original
This page is a summary of: Beyond the M-spike - Immunoparesis and Multiple Myeloma. A narrative review, Immunology Letters, August 2026, Elsevier,
DOI: 10.1016/j.imlet.2026.107236.
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