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Abstract：
BACKGROUND: The impact of chemoimmunotherapy (CIT) on immunoglobulin (Ig) quantities in patients with chronic lymphocytic leukemia (CLL) has not been extensively studied.
METHODS: We analyzed Ig levels in 45 stable patients with indolent CLL (without indication for treatment) and 87 patients with progressive disease before first-line treatment. Fifty-five patients were evaluated again after the treatment with CIT.
RESULTS: We observed significantly lower levels of all Ig classes and subclasses in patients with progressive disease compared to patients with indolent disease. After treatment, median IgA increased from 0.59 g/L to 0.74 g/L (p = 0.0031). In stable patients, lower IgA2 was associated with shorter time to first treatment, although it did not reach statistical significance (p = 0.056). Shorter overall survival was observed in patients with progressive disease and lower IgG2 (p = 0.043). Surprisingly, among the patients with progressive CLL, unmutated IGHV genes were associated with higher levels of IgG, IgG1 and IgM, while TP53 mutation and/or 17p deletion were associated with higher levels of IgA and IgA1.
CONCLUSIONS: CIT may lead to increase in IgA levels. Hypogammaglobulinemia is more common in patients with progressive CLL and unmutated IGHV or TP53 dysfunction.
METHODS: We analyzed Ig levels in 45 stable patients with indolent CLL (without indication for treatment) and 87 patients with progressive disease before first-line treatment. Fifty-five patients were evaluated again after the treatment with CIT.
RESULTS: We observed significantly lower levels of all Ig classes and subclasses in patients with progressive disease compared to patients with indolent disease. After treatment, median IgA increased from 0.59 g/L to 0.74 g/L (p = 0.0031). In stable patients, lower IgA2 was associated with shorter time to first treatment, although it did not reach statistical significance (p = 0.056). Shorter overall survival was observed in patients with progressive disease and lower IgG2 (p = 0.043). Surprisingly, among the patients with progressive CLL, unmutated IGHV genes were associated with higher levels of IgG, IgG1 and IgM, while TP53 mutation and/or 17p deletion were associated with higher levels of IgA and IgA1.
CONCLUSIONS: CIT may lead to increase in IgA levels. Hypogammaglobulinemia is more common in patients with progressive CLL and unmutated IGHV or TP53 dysfunction.
摘要：
背景：化学免疫疗法（CIT）对慢性淋巴细胞白血病（CLL）患者免疫球蛋白（Ig）量的影响尚未得到广泛研究。
方法：我们分析了45例稳定的无痛性CLL患者（无治疗指征）和87例进行性疾病患者一线治疗前的Ig水平。55名患者在接受CIT治疗后再次接受评估。
结果：我们观察到，与无痛性疾病患者相比，进行性疾病患者的所有Ig类别和亚类的水平均显着降低。治疗后,中位数IgA从0.59g/L增加到0.74g/L(p=0.0031).在稳定的患者中，较低的IgA2与较短的首次治疗时间相关，尽管没有达到统计学意义（p=0.056）。在患有进行性疾病和较低IgG2的患者中观察到较短的总生存期(p=0.043)。令人惊讶的是,在进行性CLL患者中，未突变的IGHV基因与较高的IgG水平相关，IgG1和IgM，而TP53突变和/或17p缺失与较高的IgA和IgA1水平相关。
结论：CIT可能导致IgA水平升高。低丙种球蛋白血症在患有进行性CLL和未突变的IGHV或TP53功能障碍的患者中更常见。
方法：我们分析了45例稳定的无痛性CLL患者（无治疗指征）和87例进行性疾病患者一线治疗前的Ig水平。55名患者在接受CIT治疗后再次接受评估。
结果：我们观察到，与无痛性疾病患者相比，进行性疾病患者的所有Ig类别和亚类的水平均显着降低。治疗后,中位数IgA从0.59g/L增加到0.74g/L(p=0.0031).在稳定的患者中，较低的IgA2与较短的首次治疗时间相关，尽管没有达到统计学意义（p=0.056）。在患有进行性疾病和较低IgG2的患者中观察到较短的总生存期(p=0.043)。令人惊讶的是,在进行性CLL患者中，未突变的IGHV基因与较高的IgG水平相关，IgG1和IgM，而TP53突变和/或17p缺失与较高的IgA和IgA1水平相关。
结论：CIT可能导致IgA水平升高。低丙种球蛋白血症在患有进行性CLL和未突变的IGHV或TP53功能障碍的患者中更常见。
