title: A nationwide study of acquired C1-inhibitor deficiency in France: Characteristics and treatment responses in 92 patients.
abstract: Acquired angioedema (AAE) due to C1-inhibitor (C1INH) deficiency is rare. Treatment options for acute attacks are variable and used off-label. Successful treatment of the associated lymphoma with rituximab seems to prevent acute attacks in subjects with AAE. The aim of this study was to describe AAE manifestations, its associated diseases, and patients' responses to treatments in a representative cohort.A retrospective nationwide study was conducted in France. The inclusion criteria were recurrent angioedema attacks and an acquired decrease in functional C1INH <50% of the reference value.A total of 92 cases were included, with a median age at onset of 62 years. Facial edema and abdominal pain were the most frequent symptoms. Fifteen patients were hospitalized in the intensive care unit because of laryngeal edema, and 1 patient died. Anti-C1INH antibodies were present in 43 patients. The associated diseases were primarily non-Hodgkin lymphoma (n = 44, with 24 splenic marginal zone lymphomas) and monoclonal gammopathy of undetermined significance (n = 24). Three patients had myeloma, 1 had amyloid light-chain (of immunoglobulin) (AL) amyloidosis, 1 patient had a bronchial adenocarcinoma, and 19 patients had no associated disease. Icatibant relieved the symptoms in all treated patients (n = 26), and plasma-derived C1INH concentrate in 19 of 21 treated patients. Six patients experienced thromboembolic events under tranexamic acid prophylaxis. Rituximab prevented angioedema in 27 of 34 patients as a monotherapy or in association with chemotherapy. Splenectomy controlled AAE in 7 patients treated for splenic marginal zone lymphoma. After a median follow-up of 4.2 years, angioedema was on remission in 52 patients.AAE cases are primarily associated with indolent lymphoma-especially splenic marginal zone lymphoma-and monoclonal gammopathy of undetermined significance but not with autoimmune diseases or other conditions. Icatibant and plasma-derived C1INH concentrate control attacks; splenectomy and immunochemotherapy prevent angioedema in lymphoma setting.
authors.affiliation: Internal Medicine Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, DHU i2B, Paris 6 University, Paris Hematology Department, Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris Immunology Laboratory, University Hospital, Grenoble Centre de Référence et d'Etude des Angioedèmes à Kinine (CREAK) , Grenoble Public Health Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University Immunology Laboratory, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris 5 University, Paris Joint Unit 1036 CNRS-CEA-INSERM, University Grenoble Alpes Internal Medicine Department, University Hospital, Grenoble Université Joseph Fourier Grenoble, GREPI/AGIM CNRS FRE 3405, Grenoble Internal Medicine Department, La Conception Hospital, AP-HM, Marseille Internal Medicine and Clinical Immunology Department, Lille University Hospital LIRIC, INSERM UMR 995, EA2686, Lille Dermatology Department, L'UNAM Université, University Hospital, Angers, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gobert
authors.forename: Romain
authors.initials: R
authors.lastname: Paule
authors.forename: Denise
authors.initials: D
authors.lastname: Ponard
authors.forename: Pierre
authors.initials: P
authors.lastname: Levy
authors.forename: Véronique
authors.initials: V
authors.lastname: Frémeaux-Bacchi
authors.forename: Laurence
authors.initials: L
authors.lastname: Bouillet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boccon-Gibod
authors.forename: Christian
authors.initials: C
authors.lastname: Drouet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gayet
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Ludovic
authors.initials: L
authors.lastname: Martin
authors.forename: Arsène
authors.initials: A
authors.lastname: Mekinian
authors.forename: Véronique
authors.initials: V
authors.lastname: Leblond
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000799:Angioedema / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D050718:Complement C1 Inhibitor Protein / Q000032:analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D050718:Complement C1 Inhibitor Protein