Objective: Diffuse-large-B-cell-lymphoma (DLBCL) can complicate
B-cell-primary-immunodeficiencies (PIDs) course or induce total
gamma-globulin level (TGL) lowering, whose clinical status as an
effective secondary immunodeficiency (SID) remains unspecified. This
study aims to assess the frequency, clinical and prognostic relevance of
the lowest TGLs discovered at DLBCL diagnosis. Results: In a two year
monocentric retrospective cohort, 96 patients diagnosed with DLBCL who
had a serum electrophoresis (SEP) were included. Patients were divided
into the lowest (L)- and the highest (H)-TGLs (TGL ≤5.5 g/L and TGL
>5.5 g/L) subgroups and compared for outcomes, including
fatal infectious events. In our cohort, 12 (12.5%; 8 males; median age:
68 [55—82] years) exhibited L-TGL. There was no differences
regarding demographics, Ann-Arbor-lymphoma-stages, inflammatory
parameters or chemotherapy regimen between both groups. However, overall
(10/12, 83.3% versus 22/96, 26.2%; p=0.03) and infection-related death
rates (10/12, 83% versus 6/96, 6.2%; p<0.001) were
significantly higher in the L-TGL group. Conclusion: We demonstrate for
the first time the strong negative impact of L-TGL on overall and
infection-related mortality in DLBCL. Prospective studies should
distinguish DLBCL-related SIDs from preexisting humoral PIDs, using
biomolecular testing and post-treatment TGLs monitoring to determine the
best management strategy for infectious risk during DLBCL treatment in
L-TGL context.
The Serum Gamma-Globulin-Level in Malignant Disease