Clinical and Biological Features Of Multiple Myeloma (MM) and Monoclonal Gammopathies In Patients With Human Immunodeficiency Virus (HIV) Infection
Authors: Talbot Alexis , Gérard Laurence , Szalat Raphael , Boutboul David , Harel Stephanie , Lazareth Anne , Malphettes Marion , Asli Bouchra , Galicier Lionel , Fieschi Claire , Oksenhendler Eric , Fermand Jean Paul , Arnulf Bertrand 
Published: October 2019

Abstract

Background
Monoclonal gammopathies (MoG) and HIV infection are two common diseases. A higher incidence of MoG of undetermined significance (MGUS) has been suggested in HIV patients (pts).
The clinical outcome of MGUS and the characteristics of MM in such patients are largely unknown. In the last decade, therapeutics advances have improved the prognosis of both diseases.
We report the laboratory findings and clinical course of 18 HIV infected patients with a detectable serum monoclonal protein( MGUS, MM, plasma cell leukemia) treated in our center.

Patients, disease and methods
Patients’ demographic characteristics, stage of HIV infection and clinical course were studied. Laboratory studies included determination of CD 4 T-lymphocyte cell counts, HIV loads, serum protein electrophoresis, Ig isotype, hemoglobin, serum β2-microglobulin, calcium and creatinine levels, bone marrow aspiration with cytogenetic analysis at diagnosis.

Results
18 pts (9 MGUS/stage I asymptomatic myeloma, 6 stage III myeloma, 1 leukemia plasma cell and 2 multiple plasmocytomas) were studied. The median age at diagnosis was 54.5 years (38,75). The median age at diagnosis of HIV infection was 42 years (29,68). the time Median between seropositivity and monoclonal gammopathy was 10.5 years. 1 patient's HIV status was discovered during the treatment of myeloma. 14 patients received protease inhibitors, including 9 before developing gammopathy. The monoclonal gammapathy was IgG Kappa for 9 patients,IgG Lambda for 6.
At the diagnosis of gammopathyt the median CD 4 T lymphocyte count was 442 cells/µL(range 190-915). Half of the patients had negative HIV viral load (the median of the others was 9904 copies/ml).
A polyclonal hypergammaglobulinemia (median 15.4 g / l (3.6, 26.9)) was found in addition to the Ig monoclonal in 17 patients and one patient had a symptomatic immunoparesis with repeated infections. Two patients with asymptomatic MM progressed with a period of time of 6and 11 years.
All patients with symptomatic myeloma had bone lesions, 3 had an hypercalcemia ( including a case of primary hyperparathyroidism), 2 patients had kidney injury ( 1 end stage renal disease requiring hemodialysis). Extramedullary lesions were found in 5 patients (lymph node).
11 patients have been treated with chemotherapy, 4 received autologous stem cell transplantation and 7 relapsed. The median event free survival was 4 years. 4 patients died of disease. The overal survivalwas 4.25 years.

Conclusion
The presence of a monoclonal gammapathy or asymptomatic myeloma with infection by the human immunodeficiency virus does not seem to change the clinical presentation at diagnosis. The prognosis myeloma does not seem different from the HIV non infected patients population infected and justifies a similar therapeutic approach, including therapeutic intensification and novel agents.

Disclosures:
No relevant conflicts of interest to declare.