Clinical, immunological, and molecular analysis in a large cohort of patients with X-linked agammaglobulinemia: an Italian multicenter study.
A questionnaire-based retrospective clinical and immunological survey was conducted in 73 males with a definite diagnosis of X-linked agammaglobulinemia based on BTK sequence analysis. Forty-four were sporadic and 29 familial cases. At December 2000, the patients' ages ranged from 2 to 33 years; mean age at diagnosis and mean duration of follow-up were 3.5 and 10 years respectively. After the mid-1980s all but 2 were on intravenous immunoglobulin (IVIG) substitution therapy, with residual IgG >500 mg/dl in 94% of the patients at the time of enrollment. Respiratory infections were the most frequent manifestation both prior to diagnosis and over follow-up. Chronic lung disease (CLD) was present in 24 patients, in 15 already at diagnosis and in 9 more by 2000. The cumulative risk to present at diagnosis with CLD increased from 0.17 to 0.40 and 0.78 when the diagnosis was made at the ages of 5, 10, and 15 years respectively. For the 9 patients who developed CLD during follow-up, the duration of follow-up, rather than age at diagnosis; previous administration of intramuscular immunoglobulin; and residual IgG levels had a significant effect on the development of CLD. Chronic sinusitis was present in 35 patients (48%), in 15 already at diagnosis and in 20 by 2000. Sistemic infections such as sepsis and meningitis/meningoencephalitis decreased over follow-up, probably due to optimal protection provided by high circulating IgG levels reached with IVIG.
Plebani
Alessandro
A
Dipartimento di Pediatria, Università di Brescia, Italy. plebani@master.cci.unibs.it
Soresina
Annarosa
A
Rondelli
Roberto
R
Amato
Giorgio M
GM
Azzari
Chiara
C
Cardinale
Fabio
F
Cazzola
Gianantonio
G
Consolini
Rita
R
De Mattia
Domenico
D
Dell'Erba
Grazia
G
Duse
Marzia
M
Fiorini
Maurilia
M
Martino
Silvana
S
Martire
Baldassarre
B
Masi
Massimo
M
Monafo
Virginia
V
Moschese
Viviana
V
Notarangelo
Luigi D
LD
Orlandi
Paola
P
Panei
Pietro
P
Pession
Andrea
A
Pietrogrande
Maria C
MC
Pignata
Claudio
C
Quinti
Isabella
I
Ragno
Vanda
V
Rossi
Paolo
P
Sciotto
Antonella
A
Stabile
Achille
A
D000293:Adolescent; D000328:Adult; D000077329:Agammaglobulinaemia Tyrosine Kinase; D000361:Agammaglobulinemia / Q000150:complications* / Q000235:genetics* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005500:Follow-Up Studies; D008040:Genetic Linkage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D009154:Mutation; D011505:Protein-Tyrosine Kinases / Q000235:genetics; D014960:X Chromosome
D016756:Immunoglobulins, Intravenous; D011505:Protein-Tyrosine Kinases; D000077329:Agammaglobulinaemia Tyrosine Kinase; C000625949:BTK protein, human