Pavlina Kralickova, Czech Republic
Faculty of Medicine, Charles University and University Hospital Hradec Kralova Institute od Allergology and Clinical ImmunologyPresenter of 1 Presentation
ARE THERE ANY SIGNIFICANT MARKERS FOR INITIATION OF PREEMPTIVE IMMUNOGLOBULIN SUBSTITUTION THERAPY IN NEWLY DIAGNOSED PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)?
Abstract
Background and Aims
Infectious complications in patients with CLL represent the main cause of their morbidity and mortality with 50-60 % of all disease-related deaths. The aim of our study was to identify potential risk factors such as cytogenetic aberrations, immunoglobulin heavy chain variable region (IGVH) mutational status, and hypogammaglobulinaemia with emphasis on anti-pneumococcal capsular polysaccharide (anti-PCP) and natural anti-galactosyl (anti-Gal) antibodies.
Methods
Study participants comprised 96 CLL patients (67 ± 9 years) and 76 age-matched healthy individuals. The CLL patients were newly diagnosed, not exposed to any antipneumococcal vaccine. Each blood sample was tested for total IgG, IgA, and IgM; anti-Gal IgG, IgA, and IgM; and anti-PCP IgG, IgG2 and IgA. Patients were sorted according to Rai stage, cytogenetic aberrations, IGVH mutational status and experience of severe bacterial infections during the last year.
Results
All measured humoral parameters (excluding anti-Gal IgG) negatively correlated with Rai stage. The IgG level less than 4 g/L were observed in 9 % and unprotective anti-PCP IgG levels in 22 % of CLL patients. 30 patients developed severe bacterial infection. Despite the fact that almost all measured parameters (except anti-PCP IgG2) were significantly lower in CLL group compared to healthy controls, no significant difference between patients with and without history of severe bacterial infection in relation to all followed factors were observed.
Conclusions
Characteristics such as genetic abberations, IGVH status, immunoglobulin level, anti-PCP or anti-Gal antibodies do not seem to predict severe bacterial infection risk in newly diagnosed CLL patients. Therefore preemptive immunoglobulin substitution is not indicated in this group.