title: Antibody deficiency secondary to chronic lymphocytic leukemia: Should patients be treated with prophylactic replacement immunoglobulin?
abstract: Hypogammaglobulinemia is a common finding in chronic lymphocytic leukemia (CLL). Its incidence increases with disease duration and stage such that it is present in up to 85 % of patients at some point in their disease course. It is therefore important to monitor patients for the development of an antibody deficiency. However, not all patients with antibody deficiency secondary to CLL are symptomatic with bacterial infections. In addition patients are susceptible to viral, fungal and opportunistic infections as a result of iatrogenic immunosuppression and through a variety of disease-related mechanisms, which affect cellular immunity and phagocytes. Published guidelines suggest that patients with a history of recurrent bacterial infections and a documented failure of antibody production should be treated with antibiotic prophylaxis in the first instance, with replacement immunoglobulin reserved for those who continue to suffer with significant bacterial infections. Here we present a review of the existing literature in order to provide a practical approach, based on best available evidence, to the investigation, monitoring and treatment of patients with antibody failure secondary to CLL; and we highlight areas in which further studies are needed.
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Oxford, UK, fatima.dhalla@doctors.org.uk.
authors.forename: Fatima
authors.initials: F
authors.lastname: Dhalla
authors.forename: Mary
authors.initials: M
authors.lastname: Lucas
authors.forename: Anna
authors.initials: A
authors.lastname: Schuh
authors.forename: Malini
authors.initials: M
authors.lastname: Bhole
authors.forename: Rashmi
authors.initials: R
authors.lastname: Jain
authors.forename: Smita Y
authors.initials: SY
authors.lastname: Patel
authors.forename: Siraj
authors.initials: S
authors.lastname: Misbah
authors.forename: Helen
authors.initials: H
authors.lastname: Chapel
mesh_terms: D000361:Agammaglobulinemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D019072:Antibiotic Prophylaxis; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000276:immunology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology
chemical_list: D007136:Immunoglobulins