Clinical relevance of hypogammaglobulinemia, clinical and biologic variables on the infection risk and outcome of patients with stage A chronic lymphocytic leukemia

Leuk Res. 2017 Jun;57:65-71. doi: 10.1016/j.leukres.2017.02.011. Epub 2017 Feb 27.

Abstract

The prognostic effect of hypogammaglobulinemia (HGG), clinical and biologic characteristics on the infection risk and outcome has been retrospectively analyzed in 899 patients with stage A chronic lymphocytic leukemia (CLL). Low levels of IgG were recorded in 19.9% of patients at presentation, low levels of IgM and/or IgA in 10.4% and an additional 20% of patients developed HGG during the course of the disease. Before the start of any treatment, 160 (12.9%) patients experienced at least one grade ≥3 infection requiring a systemic anti-infective treatment and/or hospitalization. While IgG levels at diagnosis were not associated with an increased risk of grade ≥3 infection or with an adverse outcome, a significantly increased rate of grade ≥3 infections was recorded in patients with unmutated IGHV (p=0.011) and unfavorable FISH aberrations (p=0.009). Late onset HGG, more frequently recorded in patients with Rai stage I-II (p=0.001) and unmutated IGHV (p=0.001), was also associated with a higher rate of severe infections (p=0.002). These data indicate that, stage A patients with clinical and biologic characteristics of a more aggressive disease develop more frequently late onset HGG, grade ≥3 infections and require a closer clinical monitoring.

Keywords: A stage; Chronic lymphocytic leukemia; Hypogammaglobulinemia; Immunoglobulins; Infections.

MeSH terms

  • Adult
  • Agammaglobulinemia / complications*
  • Agammaglobulinemia / diagnosis
  • Aged
  • Aged, 80 and over
  • Humans
  • Immunoglobulin G / blood
  • Infections / etiology*
  • Leukemia, Lymphocytic, Chronic, B-Cell / complications*
  • Leukemia, Lymphocytic, Chronic, B-Cell / pathology
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk
  • Single-Domain Antibodies / blood
  • Treatment Outcome

Substances

  • Immunoglobulin G
  • Single-Domain Antibodies