CLL Coverage from Every Angle

Are Immunoglobulin Alterations Prognostic of Outcomes in CLL?

By: Justine Landin, PhD
Posted: Tuesday, October 20, 2020

Monoclonal gammopathy and abnormal immunoglobulin (Ig) levels are associated with reduced treatment-free survival in patients with chronic lymphocytic leukemia (CLL), according to Luca Laurenti, MD, of The Gemelli University Hospital in Rome, and colleagues. However, compared with normal Ig levels, these Ig abnormalities seemed to have no significant impact on overall survival. This work was published in the British Journal of Haematology.

A total of 1,505 patients, ranging from 26 to 96 years old, were included in this retrospective, multicenter study. Subjects were required to have been diagnosed with CLL via flow cytometry and had received at least 2 years of follow-up. Patients with CLL were then divided into groups that exhibited IgG gammopathy, IgM gammopathy, reduced Ig levels, or normal Ig levels. Those with reduced or normal Ig levels were also required to have no M-protein detected via serum protein electrophoresis. Normal Ig levels were defined as 700–1,600 mg/L of IgG, 70–400 mg/L of IgA, and 40–230 mg/L of IgM. The detection of Ig levels less than normal values was defined as hypogammaglobulinemia.

Ig levels in the majority of patients were found to be normal (72%). The most common type of Ig abnormality was hypogammaglobulinemia (13.2%), followed by IgG gammopathy (10%) and IgM gammopathy (4.8%). IgG abnormalities were associated with greater occurrences of trisomy 12. IgM paraprotein appeared to be the most severe Ig abnormality, as patients with this abnormality also exhibited a significantly more advanced Binet/Rai stage and del(17p)/TP53 mutation. Compared with subjects who had normal Ig levels, patients with CLL who exhibited any type of IgG abnormality had shorter treatment-free survival at 120 months. Still, no difference was observed in overall survival.

Disclosure: The authors reported no conflicts of interest.

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