[Eric]

Normal Immunoglobulin Suppression

by Eric on Sat Jun 19, 2010 3:51 am

Dear Dr. Berenson,

I have a couple questions about myeloma patients' normal immunoglobulins. First, which drugs suppress them? I have used cyclophosphamide as part of my most recent chemo regimen and my uninvolved immunoglobulins seem to drop quite dramatically, even for months after the conclusion of therapy. Is this typical of cyclophosphamide and/or of other drugs used to treat the myeloma itself?

And second, why, after therapy has concluded and the myeloma has temporarily disappeared, do the normal, healthy immunoglobulins not seem to recover much? I guess I am assuming that because the marrow has been cleaned out of excess plasma cells, normal immunoglobulins would then get a chance to increase. Perhaps you can explain this?

I thank you very much for taking the time to thoughtfully answer my questions as well as other forum questions. Your work is deeply appreciated.

[Dr. Craig Hofmeister]

Re: Normal Immunoglobulin Suppression

by Dr. Craig Hofmeister on Tue Sep 07, 2010 5:23 pm

I'm not Dr. Berenson, but I will make an attempt to answer this question and I hope you don't mind.

1) Any chemotherapy drug suppresses your normal immunoglobulins -- things like melphalan, cyclophosphamide, doxorubicin, etc. To my knowledge Revlimid and Velcade do not. These drugs are toxic to any dividing cell(s) and hence are toxic to plasma cells that are actively secreting normal immunoglobulins.

2) Two possibilities -- a) the treatment didn't actually kill as many myeloma cells as you think (even though there is little or no circulating myeloma protein) and hence your normal plasma cells are reflexively suppressed; b) you've had so much treatment that you have so few normal plasma cells, and likely so few plasma cell progenitors, that you can't make normal immunoglobulins.