How common is it for myeloma patients on Revlimid and / or Velcade to develop simultaneous suppression of ALL three main types of immunoglobulin, i.e., IgA, IgG, IgM?
Can therapy induced immunosuppression be expected to persist as long as one continues on maintenance therapy?
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Re: Suppression of all 3 major immunoglobulins - how common?
I don't know how common it is but I experienced the same thing. I was diagnosed in Feb 2009 and was started on RVD (Rev 10 mg, Velcade infusion and 40 mg of Dex)
Over time the dosages were reduced so that by early July 2012, I was getting Velcade only once every 2 weeks and Dex was down to 20 mg once every 2 weeks. I was still on the Revlimid - same 10 mg dosage once a day on 21 off 7).
I have IgG Kappa multiple myeloma.
My readings during this period (Feb 2009 - June 2012) were all below normal:
Normal ranges
IgA - 84-474 my typical range 42-52
IgG 681-1648 my typical range 470-670
IgM 48-312 my typical range 33-43
My white counts would also be low most of the time with readings 3.3-4.3 (normal is 4.8-10.8)
However all of this time my ANC Neu would generally be in the normal range usually 2.2-2.6 (normal is 1.5-6.5
As I have posted in other threads I become very sick in July 2012 (viral meningitis and C Diff) and my oncologist dropped the Revlimid and started my on IVIG.
Since July 2012 my IgG and IgM have all been in the normal range with the IgA still tracking below normal but somewhat higher now 50-75.
I have also since this change in treatment have not been sick and avoided all upper respiratory and intestinal infections.
My oncologist believes that the Revlimid was partially responsible for the low readings. Certainly the IVIG has helped a lot.
Ron
Over time the dosages were reduced so that by early July 2012, I was getting Velcade only once every 2 weeks and Dex was down to 20 mg once every 2 weeks. I was still on the Revlimid - same 10 mg dosage once a day on 21 off 7).
I have IgG Kappa multiple myeloma.
My readings during this period (Feb 2009 - June 2012) were all below normal:
Normal ranges
IgA - 84-474 my typical range 42-52
IgG 681-1648 my typical range 470-670
IgM 48-312 my typical range 33-43
My white counts would also be low most of the time with readings 3.3-4.3 (normal is 4.8-10.8)
However all of this time my ANC Neu would generally be in the normal range usually 2.2-2.6 (normal is 1.5-6.5
As I have posted in other threads I become very sick in July 2012 (viral meningitis and C Diff) and my oncologist dropped the Revlimid and started my on IVIG.
Since July 2012 my IgG and IgM have all been in the normal range with the IgA still tracking below normal but somewhat higher now 50-75.
I have also since this change in treatment have not been sick and avoided all upper respiratory and intestinal infections.
My oncologist believes that the Revlimid was partially responsible for the low readings. Certainly the IVIG has helped a lot.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Suppression of all 3 major immunoglobulins - how common?
Thanks, Ron, for sharing this. I have been off Revlimid for about four months so, at least in my case, the low numbers are probably not due to Revlimid. I will pursue this question further and if I manage to get some good information, I will share with you and the rest of the community.
Re: Suppression of all 3 major immunoglobulins - how common?
Hi mrozdav,
My experience has been similar to Ron's.
I was on Revlimid maintenance from around the end of Sept, 2014 - early Aug, 2015. I have IgA kappa multiple myeloma. My IgA numbers began to stabilize in early 2014. So looking back since March 2014 (20 measurements), here are my means:
IgA - 39.9 (normal: 40-350 mg/dL)
IgG - 635.2 (normal: 650-1,600 mg/dL)
igM - 10.7 (normal: 50-300 mg/dL)
My WBC and ANC numbers have also always been below normal during this time. I've received 2 or 3 Neupogen shots to boost ANC counts during Revlimid maintenance.
The only problems with infections I've had have been one or two colds that have turned into sinus infections, all during the winters. That's been my Achilles heel for infections for many years, going back way before I was diagnosed with multiple myeloma.
Now that I'm off maintenance, it will be interesting to see if these numbers increase. Sure, hoping IgA stays low, though.
Hope this is a help.
Mike
My experience has been similar to Ron's.
I was on Revlimid maintenance from around the end of Sept, 2014 - early Aug, 2015. I have IgA kappa multiple myeloma. My IgA numbers began to stabilize in early 2014. So looking back since March 2014 (20 measurements), here are my means:
IgA - 39.9 (normal: 40-350 mg/dL)
IgG - 635.2 (normal: 650-1,600 mg/dL)
igM - 10.7 (normal: 50-300 mg/dL)
My WBC and ANC numbers have also always been below normal during this time. I've received 2 or 3 Neupogen shots to boost ANC counts during Revlimid maintenance.
The only problems with infections I've had have been one or two colds that have turned into sinus infections, all during the winters. That's been my Achilles heel for infections for many years, going back way before I was diagnosed with multiple myeloma.
Now that I'm off maintenance, it will be interesting to see if these numbers increase. Sure, hoping IgA stays low, though.
Hope this is a help.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Suppression of all 3 major immunoglobulins - how common?
I too have had significant suppression of all three immune globulins. This was while on carfilzomib, lenalidomide and dex, and also while subsequently on cyclophosphamide, pomalidomide and dex. I think it's fairly common.
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Suppression of all 3 major immunoglobulins - how common?
Severe depression in all three immunoglobulins from Velcade too, except the targeted one IGG unfortunately. Less so with Revlimid in the past. Sometimes below detectable levels, I would see the “<” or less than some minimal levels on lab results.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Suppression of all 3 major immunoglobulins - how common?
Been on Velcade/Dex since September 2008 and in remission since February 2009. But severe suppression of all three immunoglobulins has occurred. Most recent results are:
IgG: 453
IgA: 31
IgM: 15
I think this is common with IgG myeloma.
IgG: 453
IgA: 31
IgM: 15
I think this is common with IgG myeloma.
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LarryGaito - Name: Larry Gaito
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2007
- Age at diagnosis: 62
Re: Suppression of all 3 major immunoglobulins - how common?
Mine are all suppressed as well. I am curious, Ron, what IVIG is. Also, I am curious about any ways that people know to boost the immune system, other than eating well, taking supplements, exercising, and getting enough sleep. I've had pneumonia twice in the past six months and would like to avoid getting it again!
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Ginny - Name: Ginny
- Who do you know with myeloma?: self and four friends
- When were you/they diagnosed?: October, 2012
- Age at diagnosis: 62
Re: Suppression of all 3 major immunoglobulins - how common?
Ginny, have you had the pneumonia vaccine, PneumoVac, or a vaccination similar to that? Even for seniors over age 65, it is recommended, and for immune compromised patients also. I have had that vaccine, and not had pneumonia. (My immunoglobulin levels are normal tho.) You could ask your oncologist about that, if you haven't had that vaccination yet.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Suppression of all 3 major immunoglobulins - how common?
Ginny, My myeloma specialist told me the other day that immunosuppression of all three immunoglobulins is very common, is induced by my medications, and in all likelihood will continue for as long as I continue on maintenance, i.e., for the rest of my life.
Relevant to your question to Ron: IVIG is IgG that is given by infusion to myeloma patients who are very low on IgG and suffer from recurring infections. My specialist said that she would consider ordering it for me if I had recurring serious infections. More specifically, she added that she would order it if I had two such infections within a year or even within a shorter period of time depending on the type of infections involved. My local oncologist said virtually the same thing, but she added that there were possible side effects to the IVIG (which we did not discuss). My understanding is that IVIG can be very helpful. I would be interested to learn from others what side effects have been experienced.
Relevant to your question to Ron: IVIG is IgG that is given by infusion to myeloma patients who are very low on IgG and suffer from recurring infections. My specialist said that she would consider ordering it for me if I had recurring serious infections. More specifically, she added that she would order it if I had two such infections within a year or even within a shorter period of time depending on the type of infections involved. My local oncologist said virtually the same thing, but she added that there were possible side effects to the IVIG (which we did not discuss). My understanding is that IVIG can be very helpful. I would be interested to learn from others what side effects have been experienced.
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