Immunoparesis - Multiple Myeloma Center for Nurses



Immunoparesis is a driver of compromised immune function in many patients with
multiple myeloma (MM).1-3

It is defined as the reduction in levels of ≥1 immunoglobulins not associated with the patient’s specific myeloma variant (uninvolved immunoglobulins). Immunoparesis suppresses B cells (hypogammaglobulinemia), which can put the patient at increased risk for infection.1-3

Signs and Symptoms

  • Infection is a contributor to morbidity and mortality in MM. So it is important to emphasize that patients take precautions to prevent infection, such as handwashing and good personal hygiene, proper food preparation, and avoiding large crowds3,4
  • Immunoparesis is often present at diagnosis of active MM and is a prognostic marker for progression of monoclonal gammopathy of undetermined significance (MGUS) or smoldering MM to symptomatic myeloma5
  • Quantitative and qualitative immunoglobulin testing can help determine which uninvolved immunoglobulins are below normal levels5


  1. Gonzalez De La Calle V, Sobejano E, Davila J, et al. Immunoparesis recovery as predictor marker of progression after autologous stem cell transplantation in multiple myeloma. Blood. 2015;126(23):4356.
  2. Munshi NC, Anderson KC. Plasma cell neoplasms. In: DeVita VT, et al, eds. Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:2155‐2188.
  3. Brigle K, Pierre A, Finley-Oliver E, Faiman B, Tariman JD, Miceli T; International Myeloma Foundation Nurse Leadership Board. Myelosuppression, bone disease, and acute renal failure: evidence-based recommendations for oncologic emergencies. Clin J Oncol Nurs. 2017;21(5 suppl):60-76.
  4. Ludwig H, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group recommendations for global myeloma care. Leukemia. 2014;28(5):981-992.
  5. Sørrig R, Klausen TW, Salomo M, et al; the Danish Myeloma Study Group. Immunoparesis in newly diagnosed multiple myeloma patients: effects on overall survival and progression free survival in the Danish population. PLOS One. 2017;12(12):e0188988.