Mathieu Blot1, Pierre Boyer2, Maxime Samson3, Sylvain Audia3, Hervé Devilliers4, Vanessa Leguy1, Sabine Berthier1, Jean-François Besancenot4, Bernard Lorcerie5, Daniela Lakomy6, Bernard Bonnotte7. 1. Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France. 2. Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France. 3. Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France. 4. Faculty of Medicine, University of Burgundy, Dijon, France; Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, 21079 Dijon, France. 5. Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France. 6. Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France. 7. Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France. Electronic address: Bernard.bonnotte@chu-dijon.fr.
Abstract
BACKGROUND: Although secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia. METHODS: This retrospective observational study included all adult patients with a gammaglobulin level <6.4g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin <5g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin <6.4 and ≥5g/L, mild hypogammaglobulinemia). RESULTS: Among the 4011 serum electrophoreses, 570 samples from 389 patients had gammaglobulin levels below 6.4g/L: 156 (40%) in group 1 and 233 (60%) in group 2. Mean age±SD was 67 (15) years, and sex ratio was 1.04 (M/F) with no difference between the two groups. An etiology was identified in 79% and 58% of patients in groups 1 and 2, respectively (p<0.0001). The main etiologies were similar in both groups and included malignant hemopathy treated with cytostatic agents (n=129, 33%), smoldering or newly-diagnosed hemopathy without treatment (n=49, 13%) and immunosuppressive treatment (n=91, 23%). The incidence of hypogammaglobulinemia-related infections was 22/100/year, with no significant difference between the two groups (p=0.17). Vaccination coverage against pneumococcus was 33%, and higher in group 1 (46% vs. 24%; p<0.0001). When no cause was known at inclusion, an etiology was discovered in 22/130 patients (17%), 11 in each group. CONCLUSIONS: Though mild hypogammaglobulinemia does not meet the classical criteria for hypogammaglobulinemia (<5g/L), the etiology and infectious risk are similar. It therefore requires investigation and vaccination.
BACKGROUND: Although secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia. METHODS: This retrospective observational study included all adult patients with a gammaglobulin level <6.4g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin <5g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin <6.4 and ≥5g/L, mild hypogammaglobulinemia). RESULTS: Among the 4011 serum electrophoreses, 570 samples from 389 patients had gammaglobulin levels below 6.4g/L: 156 (40%) in group 1 and 233 (60%) in group 2. Mean age±SD was 67 (15) years, and sex ratio was 1.04 (M/F) with no difference between the two groups. An etiology was identified in 79% and 58% of patients in groups 1 and 2, respectively (p<0.0001). The main etiologies were similar in both groups and included malignant hemopathy treated with cytostatic agents (n=129, 33%), smoldering or newly-diagnosed hemopathy without treatment (n=49, 13%) and immunosuppressive treatment (n=91, 23%). The incidence of hypogammaglobulinemia-related infections was 22/100/year, with no significant difference between the two groups (p=0.17). Vaccination coverage against pneumococcus was 33%, and higher in group 1 (46% vs. 24%; p<0.0001). When no cause was known at inclusion, an etiology was discovered in 22/130 patients (17%), 11 in each group. CONCLUSIONS: Though mild hypogammaglobulinemia does not meet the classical criteria for hypogammaglobulinemia (<5g/L), the etiology and infectious risk are similar. It therefore requires investigation and vaccination.
Authors: Nora Möhn; Steffen Pfeuffer; Tobias Ruck; Catharina C Gross; Thomas Skripuletz; Luisa Klotz; Heinz Wiendl; Martin Stangel; Sven G Meuth Journal: Neurol Neuroimmunol Neuroinflamm Date: 2019-12-11