Outcome of Patients With IgD and IgM Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Retrospective CIBMTR Study

Abstract

Introduction Immunoglobulin D (IgD) and IgM multiple myeloma represent uncommon immunoglobulin isotypes, accounting for 2% and 0.5% of cases, respectively. Limited information is available regarding the prognosis of these isotypes, but they have been considered to have a more aggressive course than the more common immunoglobulin G (IgG) and IgA isotypes. In particular, the outcome after autologous hematopoietic stem cell transplantation (auto-HCT) has not been well defined. Patients and Methods Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 36 patients with IgD and 11 patients with IgM myeloma among 3578 myeloma patients who received intensive therapy and auto-HCT over a 10-year period. Results The progression-free and overall survival probabilities at 3 years were 38% (95% CI, 21%-56%) and 69% (95% CI, 51%-84%) for IgD myeloma, and 47% (95% CI, 17%-78%) and 68% (95% CI, 36%-93%), respectively, for IgM disease. Although formal statistical analysis was limited by the small sample size, these results were comparable to those for IgG and IgA patients autografted during the same time period. Transplantation-related mortality and disease relapse/progression of myeloma were also similar for all isotypes. Conclusion This analysis demonstrates comparable outcomes in all immunoglobulin isotypes. Therefore, auto-HCT should be offered to eligible patients with IgD and IgM myeloma.

Efficacy and Survival Outcome Associated with the Use of Novel Agents and Autologous Stem Cell Transplantation in Cases of Immunoglobulin D Multiple Myeloma in Korea

“…In this study, the median overall OS (37.7 months) was remarkably improved, possibly because of the use of novel agents as induction therapy, relative to the median OS (12 months) reported in our previously conducted study [11]; however, these outcomes are still shorter than those reported in studies conducted in Western countries [3, 10, 12, 13, 17, 18]. …”

“…Our previously conducted retrospective study reported poorer outcomes in cases of IgD MM, relative to the other MM isotypes, after ASCT [11]. In contrast, 2 other reports suggested that similar outcomes were observed after ASCT in cases of IgD myeloma and common isotypes of MM [12, 13]. …”

Therapy for Immunoglobulin D Plasma Cell Myeloma

“…Results are contradictory [9-12]. In a study from the Centre for Blood and Marrow Research (CIBMTR) in 36 subjects my colleagues and I found similar outcomes to persons with IgG and IgA plasma cell myeloma [13]. However, another study in 17 subjects reported worse outcomes [14].…”

Efficacy and Outcome of Allogeneic Transplantation in IgD and Nonsecretory Myeloma. A Report on Behalf of the Myeloma Subcommittee of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation

“…There have been a number of recent reports of the outcome of autologous transplantation for the rare myelomas (IgD, IgE, IgM, and nonsecretory myeloma [NS]) [1][2][3][4].…”