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Low total gamma globulin level discovery at diffuse large B cell lymphoma diagnosis predicts high risk of infection-related death: data from a monocentric retrospective study
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  • Alexandre NGUYEN,
  • Nicolas Martin-Silva,
  • Hubert de Boysson,
  • Samuel Deshayes,
  • Anne-Claire Gac,
  • Emilie Reboursière,
  • Ghandi Damaj,
  • Achille Aouba
Alexandre NGUYEN
CHU Caen
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Nicolas Martin-Silva
CHU Caen
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Hubert de Boysson
CHU Caen
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Samuel Deshayes
CHU Caen
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Anne-Claire Gac
CHU Caen Institut d'Hématologie de Basse-Normandie
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Emilie Reboursière
CHU Caen Institut d'Hématologie de Basse-Normandie
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Ghandi Damaj
CHU Caen Institut d'Hématologie de Basse-Normandie
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Achille Aouba
CHU Caen
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Abstract

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.

Peer review status:IN REVISION

21 Mar 2021Submitted to Clinical & Experimental Immunology
22 Mar 2021Assigned to Editor
22 Mar 2021Submission Checks Completed
15 Apr 2021Reviewer(s) Assigned
24 May 2021Review(s) Completed, Editorial Evaluation Pending
24 May 2021Editorial Decision: Revise Major