Risk of secondary hypogammaglobulinaemia after Rituximab and Fludarabine in indolent non-Hodgkin lymphomas: A retrospective cohort study.

The occurrence of secondary hypogammaglobulinemia (SH) after chemo-immunotherapy represents a potential side effect in patients with indolent non-Hodgkin lymphomas (iNHL). Few data are available on SH occurring after chemotherapy and/or Rituximab (R). We retrospectively investigated the incidence and the risk factors for SH and infectious complications in patients with iNHL after chemo-immunotherapy. Two hundred and sixty six patients treated between 1993 and 2011 were studied. Patients with a basal hypogammaglobulinemia or a monoclonal component were excluded. The incidence of SH was 2.2×1000 person-years (95% CI 1.6-2.9). Exposure to Fludarabine-based schedules (Fbs)±R was associated with a hazard ratio (HR) of 18.1 (95% CI: 4.3-77.0). Conversely, exposure to CHOP±R or CVP±R was not a risk factor (HR 0.3, 95% CI: 0.1-0.8; HR 0.3, 95% CI: 0.08-1.4, respectively). The role of R was studied comparing cohorts differing only for R; no differences were found comparing R-CHOP/R-CVP versus CHOP/CVP (HR 1.07, 95% CI: 0.38-3.05) and R-Fbs versus Fbs (HR 2.07, 95% CI: 0.62-6.99). Autologous stem cell transplantation (ASCT) is also a risk factor (HR: 5.2, 95% CI 2.1-13.0). SH patients presented a high risk for pneumonia development (HR 7.07 95% CI: 2.68-18.44). We recommend monitoring of serum immunoglobulins in an attempt to reduce the probability of infection after Fbs or ASCT.

Localization of extrapulmonary tuberculosis in the synovial membrane, skin, and meninges in a patient with systemic lupus erythematosus and IgG deficiency.

We report on a 31-year-old female patient with systemic lupus erythematosus (SLE) for 24 years who had a past history of skin tuberculosis (lupus vulgaris), long-term corticosteroid therapy, and IgG deficiency. She presented with monoarthritis and concomitant meningitis from skin tuberculosis after 5 years. The diagnosis of joint and meningeal tuberculosis was defined with clinical symptoms--signs and typical histopathological findings of involved synovium. Clinical improvement was achieved with antituberculous therapy. Cutaneous, articular, and cerebral manifestations of tuberculosis might have been confused with some of the lupus manifestations or lupus activation. It should be kept in mind that tuberculosis may be encountered in SLE due to the nature of the underlying disease and/or its therapy. It is also worth mentioning that, in this patient, tissues involved with extrapulmonary tuberculosis were the primary areas of involvement with SLE.

IgA and IgG2 deficiency associated with zonisamide therapy: a case report.

PURPOSE: To report a previously undescribed adverse effect, IgA/IgG subclass deficiency associated with zonisamide (ZNS) therapy. METHODS: Serum IgA and IgG subclass levels were determined by the turbidimetric immunoassay and enzyme-linked immunosorbent assay, respectively, in a 2-year-old boy with postmeningitis sequelae who was treated by ZNS. RESULTS: Four months after initiation of ZNS, combined deficiency of IgA and IgG2 was noted. After cessation of ZNS, serum IgA level was promptly increased. IgG2 level was gradually increased, but remained subnormal after 7 months. CONCLUSIONS: This case documents, for the first time, the action of ZNS on IgG immune system as well as IgA system. If patients with ZNS therapy showed IgA deficiency and recurrent infections, it is preferable to check serum IgG subclass concentrations as well.

[Effect of occupational lead exposure on the immunoglobulin concentration and cellular immune function in man]. / Influencia de la exposición ocupacional al plomo sobre la concentración de inmunoglobulinas y la función celular inmune en el hombre.

The evaluation of immunological conditions of 14 workers occupationally exposed to lead and comparison of these results with those of a non-exposed control group with similar age and sex were the aims of this study. It was determined the mean values of lead in blood. In exposed workers it was 46.9 ug/dl while in the control group it was 10.9 ug/dl. Levels of immunoglobulin decreasing while increasing lead concentration in blood were found in those exposed. It was also found a significant diminishment in the formation of rosette in relation to the control group.

IgG subclass deficiency associated with corticosteroids in obstructive lung disease.

IgG subclass levels were measured in three groups of adult patients with obstructive airways disease to discern the relationships among depressed IgG subclass levels, chronic corticosteroid use, and recurrent sinopulmonary infections. Group 1 consisted of patients with corticosteroid-dependent bronchial asthma, group 2 patients had corticosteroid-dependent chronic bronchitis/emphysema, and group 3 was comprised of asthma patients not requiring oral corticosteroids but associated with recurrent sinopulmonary infections. One or more IgG subclass deficiencies were noted in 66.7 percent of group 1, 46.7 percent of group 2, and 6.7 percent of group 3. Significant differences were noted between groups 1 and 3 (p = .0008) and between groups 2 and 3 (p = .018), but not between groups 1 and 2 (p = .5). IgG1 deficiency was the most common subclass deficiency found; 14 (77.8 percent) of 18 patients with detectable subclass deficiency demonstrated IgG1 deficiency. In this study population, IgG subclass level deficiencies appeared to be secondary to long-term low-dose corticosteroid therapy.

Phenytoin-induced IgG2 and IgG4 deficiencies in a patient with epilepsy.

A five-year-old girl with epilepsy and recurrent respiratory infections was investigated for serum IgG subclass concentrations. She was diagnosed as having a combined deficiency of IgG2 and IgG4 with a decreased serum concentration of IgA and IgG3 and was given replacement therapy with i.v. immunoglobulins. Since then, she has been free from respiratory infections. After phenytoin therapy was stopped, IgG subclass deficiency improved. This case describes the further action of phenytoin on the immune system, adding IgG subclass deficiency to the list.