[gardengirl]

How long for suppressed immunoglobulins to recover?

by gardengirl on Mon Feb 02, 2015 3:59 pm

I am wondering how long it takes for the uninvolved suppressed immunoglobins to return to normal – that is, for "immunoparesis" to end – after treatment finishes.

Thank you!

[NStewart]

Re: How long for suppressed immunoglobulins to recover?

by NStewart on Thu Feb 05, 2015 3:01 pm

I don't think that there is an answer to your question. I still have an M-spike, 0.6 g/dL, but no paresis noted. I am IgG kappa. My IgM and IgA continue to be below the normal range while my IgG is in the normal range. Of course, I am being treated. But, during the almost 3 years post transplant when I wasn't on any treatment or maintenance and my M-spike was 0, my IgM and IgA remained below normal, while the IgG was in the normal range.

So, who knows? I do know that I rarely get sick and, when I do, it's a minor respiratory-like event that resolves within a couple of days. So it appears that my immune system is working.

Nancy in Phila

[Dr. Jason Valent]

Re: How long for suppressed immunoglobulins to recover?

by Dr. Jason Valent on Mon Feb 23, 2015 4:39 pm

This is an excellent question. I am not sure that there has been a scientific study that looks at this. I did try and review available literature, but could not find anything.

I can say that, in some patients, the immune system never seems to come back to full strength. In others, it takes about 6 months to see healthy immunoglobulins return. If chronic infections are a problem, supplemental intravenous immunoglobulin can be used.

[MrPotatohead]

Re: How long for suppressed immunoglobulins to recover?

by MrPotatohead on Sat Jul 22, 2017 7:29 am

I'm two months out of my successful autologous stem cell transplant. Bone marrow biopsy shows about 1% myeloma cells, and the free light chain (FLC) assay shows undetectable free light chains (I have kappa light chain myeloma).

And yet, here are recent immunoglobulin values:

IgA < 7.83 mg/dL
IgM < 5.3 mg/dL
IgG 1,290 mg/dL

The uninvolved (IgA and IgM) immunoglobulin values remain very low, while my IgG value is within the normal range. However, it occasionally dips below normal also.

If the myeloma is gone, what is causing the immunoglobulin suppression?

Recently, Mark11 posted a study showing that approximately 50% of myeloma patients achieve recovery of their immunoglobulins after a successful autologous stem cell transplant. Why only 50%?

If the myeloma is gone, what is causing the continued immunoglobulin suppression?

If I may be permitted an editorial comment here, I find these inconsistencies and an underlying lack of knowledge to explain them very frustrating about this disease. It makes me think that, despite the constant self-congratulatory statements coming from the "thought leaders" about how much progress they are making in understanding multiple myeloma, that they in truth understand very little indeed.

I find it impossible to live what even approaches a normal life with so much ambiguity and uncertainty.

Also, I feel pretty much as I did before the stem cell transplant – extreme bone pain and fatigue. In fact, now I have bone pain in both arms and cloudy vision, neither of which I had before the transplant.

[Ron Harvot]

Re: How long for suppressed immunoglobulins to recover?

by Ron Harvot on Sat Jul 22, 2017 5:18 pm

My IgA and IgM have been suppressed as long as I have been diagnosed 8 1/2 yrs ago. That is despite being on IVIG since the summer of 2012 (not as depressed as it was before). I do note that Revlimid appears to impact my immunoglobulin. When I contracted meningitis in the summer of 2012, I was taken off Revlimid but continued to receive Velcade. I relapsed earlier this year and Revlimid at 5 mg was reintroduced. I have noticed a slight fall in the IgA and IgM readings since, but my light chains are responding positively as the kappa light chain is down 50% from where it was. Therefore, I suspect that continuous treatment has an impact on the immune system and sup­presses it, affecting some patients more than others.

[goldmine848]

Re: How long for suppressed immunoglobulins to recover?

by goldmine848 on Sat Jul 22, 2017 7:12 pm

The other thing to consider is that the "normal range" is an average. I have been told that for readings like these 15% of the population have a normal value above and 15% below the normal range. My uninvolved immunoglobulins were suppressed for quite a long time, but I was not getting infections or suffering from other illnesses, so I saw no cause for concern.