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

Abstract

Objective: Diffuse-large-B-cell-lymphoma (DLBCL) can complicate\nB-cell-primary-immunodeficiencies (PIDs) course or induce total\ngamma-globulin level (TGL) lowering, whose clinical status as an\neffective secondary immunodeficiency (SID) remains unspecified. This\nstudy aims to assess the frequency, clinical and prognostic relevance of\nthe lowest TGLs discovered at DLBCL diagnosis. Results: In a two year\nmonocentric retrospective cohort, 96 patients diagnosed with DLBCL who\nhad a serum electrophoresis (SEP) were included. Patients were divided\ninto the lowest (L)- and the highest (H)-TGLs (TGL ≤5.5 g/L and TGL\n>5.5 g/L) subgroups and compared for outcomes, including\nfatal infectious events. In our cohort, 12 (12.5%; 8 males; median age:\n68 [55—82] years) exhibited L-TGL. There was no differences\nregarding demographics, Ann-Arbor-lymphoma-stages, inflammatory\nparameters or chemotherapy regimen between both groups. However, overall\n(10/12, 83.3% versus 22/96, 26.2%; p=0.03) and infection-related death\nrates (10/12, 83% versus 6/96, 6.2%; p<0.001) were\nsignificantly higher in the L-TGL group. Conclusion: We demonstrate for\nthe first time the strong negative impact of L-TGL on overall and\ninfection-related mortality in DLBCL. Prospective studies should\ndistinguish DLBCL-related SIDs from preexisting humoral PIDs, using\nbiomolecular testing and post-treatment TGLs monitoring to determine the\nbest management strategy for infectious risk during DLBCL treatment in\nL-TGL context.