Suppression of lymphocyte responses by monocytes with untreated and treated multiple myeloma

Studies were performed on 15 untreated and 14 treated patients with multiple myeloma. The monocyte content was normal in blood but elevated in mononuclear leukocytes (MNL) from treated but not untreated patients (p<0.001). This correlated with the severity of lymphopenia in blood (p<0.001). Three patterns of immunoglobulin (Ig) synthesis emerged. (1) Most untreated patients showed normal polyclonal responses to pokeweed mitogen. (2) Of 12 treated patients, the 8 whose MNL included >30% monocytes had subnormal Ig responses to pokeweed mitogen. Ig synthesis increased when adherent cells that suppressed Ig synthesis were depleted. Suppression in vitro bore no relationship to polyclonal immunoglobulin levels in serum. (3) Three patients had early blood invasion by plasmacytoid cells. Their MNL spontaneously released large amounts of the Ig class of their serum gammopathies. Proliferative responses to phytohemagglutinin by MNL from all patients were reduced, in part due to monocytoid cell suppression and in part to intrinsic T-cell hyporesponsivenss. B- and T-cell responses in vitro are sometimes suppressed with myeloma. This is related to elevated monocyte percentages in MNL preparations. This excess of monocytes is a function of lymphopenia secondary to therapy, rather than the primary malignant process itself. No evidence was found that suppression by monocytes is qualitatively altered by myeloma or its treatment.