Disease monitoring with quantitative serum IgA levels provides a more reliable response assessment in multiple myeloma patients

Alissa Visram, Iuliana Vaxman, Abdullah S. Al Saleh, Harsh Parmar, Angela Dispenzieri, Prashant Kapoor, Martha Q. Lacy, Morie A. Gertz, Francis K. Buadi, Suzanne R. Hayman, David Dingli, Rahma Warsame, Taxiarchis Kourelis, Mustaqeem Siddiqui, Wilson Gonsalves, Eli Muchtar, John A. Lust, Nelson Leung, Robert A. Kyle, David MurrayS. Vincent Rajkumar, Shaji Kumar

Research output: Contribution to journalArticlepeer-review

Abstract

Unlike IgG monoclonal proteins (MCPs), IgA MCP quantification is unreliable due to beta-migration of IgA MCPs on serum protein electrophoresis (SPEP). The utility of nephelometric quantitative IgA (qIgA) to monitor IgA multiple myeloma (MM) is unclear. We retrospectively studied disease response kinetics using qIgA versus MCPs by SPEP, and developed and validated novel qIgA disease assessment criteria in 491 IgA MM patients. The SPEP MCP nadir occurred a median of 41 (IQR 0–102) days before the qIgA. The median time to achieve a partial response (PR) was shorter using standard IMWG versus qIgA response criteria (32 vs 58 days, p < 0.001). Stratification by qIgA criteria, unlike IMWG criteria, led to clear separation of the progression-free survival curves of patients achieving a PR or very good PR. There was a consistent trend toward earlier detection of disease progression using qIgA versus IMWG progression criteria. In conclusion, monitoring IgA MM using MCP-based IMWG criteria may be falsely reassuring, given that MCP levels on SPEP decrease faster than qIgA levels. The qIgA response criteria more accurately stratify patients based on the progression risk and may detect disease progression earlier, which may lead to more consistent measurement of trial endpoints and improved patient outcomes.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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