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Cellular immunocompetence in asymptomatic paraproteinaemia.

Several sensitive parameters of cellular immunity were studied in 20 patients with asymptomatic paraproteinaemia as judged after at least 3 years of follow-up. In vitro lymphocyte transformation by the primary immunogen haemocyanin of Helix pomatia (HPH) following immunization, by PHA, PWM and previously encountered antigens was measured, as was skin sensitization by the primary immunogen dinitrochlorobenzene (DNCB). All 12 patients with low serum paraprotein levels—benign paraproteinaemia according to common criteria— had normal parameters of cellular immunity. However, 5 of 6 patients with high IgG and IgA serum paraprotein levels had a decreased response to HPH; 3 of these 5 also had a decreased PHA response. Two patients with high IgM serum paraprotein levels had normal lymphocyte reactivity. Lymphocyte reactivity by PWM and previously encountered antigens was normal in all patients. Autologous serum culture medium did not influence the results. DNCB skin sensitization was significantly lower in the group with high serum paraprotein levels than in the group with low levels. It is concluded, that in asymptomatic paraproteinaemia, patients with high serum paraprotein levels differ from those with low paraprotein levels in their defective cellular response to primary immunogens. The significance of these findings is discussed.