title: Clinical relevance of hypogammaglobulinemia, clinical and biologic variables on the infection risk and outcome of patients with stage A chronic lymphocytic leukemia.
abstract: The prognostic effect of hypogammaglobulinemia (HGG), clinical and biologic characteristics on the infection risk and outcome has been retrospectively analyzed in 899 patients with stage A chronic lymphocytic leukemia (CLL). Low levels of IgG were recorded in 19.9% of patients at presentation, low levels of IgM and/or IgA in 10.4% and an additional 20% of patients developed HGG during the course of the disease. Before the start of any treatment, 160 (12.9%) patients experienced at least one grade ≥3 infection requiring a systemic anti-infective treatment and/or hospitalization. While IgG levels at diagnosis were not associated with an increased risk of grade ≥3 infection or with an adverse outcome, a significantly increased rate of grade ≥3 infections was recorded in patients with unmutated IGHV (p=0.011) and unfavorable FISH aberrations (p=0.009). Late onset HGG, more frequently recorded in patients with Rai stage I-II (p=0.001) and unmutated IGHV (p=0.001), was also associated with a higher rate of severe infections (p=0.002). These data indicate that, stage A patients with clinical and biologic characteristics of a more aggressive disease develop more frequently late onset HGG, grade ≥3 infections and require a closer clinical monitoring.
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy. Electronic address: mauro@bce.uniroma1.it.
authors.forename: Francesca R
authors.initials: FR
authors.lastname: Mauro
authors.affiliation: Hematology Section, Cosenza Hospital, Cosenza, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.affiliation: Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Iolanda D
authors.initials: ID
authors.lastname: Vincelli
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Petrucci
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Melissa
authors.initials: M
authors.lastname: Campanelli
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Salaroli
authors.affiliation: Hematology Section, Cosenza Hospital, Cosenza, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Uccello
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Petrungaro
authors.affiliation: Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ronco
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Raponi
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Nanni
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milano and Hematology CTMO, Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Neri
authors.affiliation: San Martino IST, Direzione Scientifica IRCCS, Genova, Italy.
authors.forename: Manlio
authors.initials: M
authors.lastname: Ferrarini
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy; Department of Molecular Medicine, Sapienza University, Rome, Italy.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Guarini
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
authors.affiliation: Hematology Section, Cosenza Hospital, Cosenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007239:Infections / Q000209:etiology*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D061905:Single-Domain Antibodies / Q000097:blood; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D061905:Single-Domain Antibodies
keywords: A stage; Chronic lymphocytic leukemia; Hypogammaglobulinemia; Immunoglobulins; Infections