Secondary humoral immunodeficiency in patiens with systemic lupus erythematosus
Authors:
Pavlína Králíčková 1; Eva Malá 1; Doris Vokurková 1; Ondřej Souček 1; Irena Krčmová 1; Zbyněk Hrnčíř 2
Authors place of work:
Ústav klinické imunologie a alergologie LF UK a FN Hradec Králové, přednosta prof. RNDr. Jan Krejsek, CSc.
1; II. interní gastroenterologická klinika LF UK a FN Hradec Králové, přednostka prof. MUDr. Marcela Kopáčová, Ph. D.
2
Published in the journal:
Vnitř Lék 2015; 61(9): 778-794
Category:
Original Contributions
Summary
Introduction:
Systemic lupus erythematosus (SLE) is a chronic autoimmune multisystem disease. The aim of our study was to clarify the frequency of decreased serum immunoglobulin levels in SLE patients. There were evaluated 799 results of serum immunoglobulin levels gained from 157 patients fulfilling revised ACR criteria in the retrospective study.
Results:
The immunoglobulin levels under the normal range were found in 29/157 (18.5 %) patients. The most frequent was isolated reduction of IgG 12/157 (7.6 %), two persons fulfilled criteria for selective IgA deficiency, and one case possible diagnosis of common variable immunodeficiency (CVID). Additionally we report two cases of SLE patients complicated by severe hypogammaglobulinaemia and infectious complications with necessity of long-term immunoglobulin substitution therapy. The diagnosis of CVID is highly probable in the first case. The second case presents sever drug-induced hypogammaglobulinaemia. This female with lymphoma history and multiorgan impairment due to acute SLE was treated with rituximab after convention therapy failure.
Conclusion:
Humoral immunodeficiency may occur in SLE patients. The monitoring of serum immunoglobulin levels could be a routine in these patients. The CVID diagnosis is possible in patients suffering from recurrent sinopulmonary infections, especially in combination with absence of lupus activity. Rituximab therapy could cause long-term suppression of B lymphocytes with secondary humoral deficiency requiring immunoglobulin substitution therapy.
Key words:
CVID – humoral immunodeficiency – lupus – rituximab – substitution therapy
Zdroje
1. Lawrence RC, Helmick CG, Arnett FC et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41(5): 778–799.
2. Chakravarty EF, Bush TM, Manzi S et al. Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data. Arthritis Rheum 2007; 56(6): 2092–2094.
3. Pons-Estel GJ, Alarcon GS, Scofield L et al. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum 2010; 39(4): 257–268.
4. Furst DE, Clarke AE, Fernandes AW et al. Incidence and prevalence of adult systemic lupus erythematosus in a large US managed-care population. Lupus 2013; 22(1): 99–105.
5. Danchenko N, Satia JA, Anthony MS. Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 2006; 15(5): 308–318.
6. Peschken CA, Esdaile JM. Rheumatic diseases in North America‘s indigenous peoples. Semin Arthritis Rheum 1999; 28(6): 368–391.
7. Carneiro-Sampaio M, Liphaus BL, Jesus AA et al. Understanding systemic lupus erythematosus physiopathology in the light of primary immunodeficiencies. J Clin Immunol 2008; 28(Suppl 1): S34-S41.
8. Horák P, Tegzová D, Závada J et al. Doporučení České revmatologické společnosti pro diagnostiku a sledování nemocných se systémovým lupus erythematotes. Čes Revmatol 2013; 21(2): 59–70.
9. Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol 1999; 93(3): 190–197.
10. Battersby AC, Cale AM, Goldblatt D et al. Clinical manifestations of disease in X-linked carriers of chronic granulomatous disease. J Clin Immunol 2013; 33(8): 1276–1284.
11. Liblau RS, Bach JF. Selective IgA deficiency and autoimmunity. Int Arch Allergy Immunol 1992; 99(1): 16–27.
12. Rankin EC, Isenberg DA. IgA deficiency and SLE: prevalence in a clinic population and a review of the literature. Lupus 1997; 6(4): 390–394.
13. Cassidy JT, Kitson RK, Selby CL. Selective IgA deficiency in children and adults with systemic lupus erythematosus. Lupus 2007; 16(8): 647–650.
14. Resnick ES, Moshier EL, Godbold JH et al. Morbidity and mortality in common variable immune deficiency over 4 decades. Blood 2012; 119(7): 1650–1657.
15. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol 1999; 92(1): 34–48.
16. Fernandez-Castro M, Mellor-Pita S, Citores MJ et al. Common variable immunodeficiency in systemic lupus erythematosus. Semin Arthritis Rheum 2007; 36(4): 238–245.
17. Geneviève M, Bonnet F, Michaux C et al. Lupus nephritis associated with common variable immunodeficiency: favourable outcome with intravenous immunoglobulin treatment. Rev Med Interne 2012; 33(6): e31-e33. Dostupné z DOI: <http://dx.doi.org/10.1016/j.revmed.2011.05.002>.
18. Suyama K, Kawasaki Y, Abe Y et al. Development of common variable immunodeficiency in IgA- and IgG2-deficient patients with systemic lupus erythematosus. Pediatr Nephrol 2012; 27(3): 489–492.
19. Torres-Salido M, Cortes-Hernandez J, Balada E et al. Systemic lupus erythematosus as a first presentation of common variable immunodeficiency associated with infrequent mannose-binding lectin gene polymorphisms. Rheumatol Int 2011; 31(4): 537–541.
20. Al Hamzi H, Al Shaikh A, Arnaout RK. Poor specific antibody response immunodeficiency (dysgammaglobulinemia) predates systemic lupus erythematosus. Lupus 2013; 22(9): 961–966.
21. Yap D, Yung S, Ma M et al. Serum immunoglobulin G level in patients with lupus nephritis and the effect of treatment with corticosteroids and mycophenolate mofetil. Lupus 2014; 23(7):678–683.
22. Yong PF, Aslam L, Karim MY et al. Management of hypogammaglobulinaemia occurring in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2008; 47(9): 1400–1405.
23. McIntyre P, Craig JC. Prevention of serious bacterial infection in children with nephrotic syndrome. J Paediatr Child Health 1998; 34(4): 314–317.
24. Lan L, Han F, Chen JH. Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis. J Zhejiang Univ Sci B 2012; 13(9): 731–744.
25. Delbe-Bertin L, Aoun B, Tudorache E et al. Does rituximab induce hypogammaglobulinemia in patients with pediatric idiopathic nephrotic syndrome? Pediatr Nephrol 2013; 28(3): 447–451.
26. Marco H, Smith RM, Jones RB et al. The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease. BMC Musculoskelet Disord 2014; 15: 178. Dostupné z DOI: <http://dx.doi.org/10.1186/1471–2474–15–178>.
27. De La Totte, I, Leandro MJ, Valor L et al. Total serum immunoglobulin levels in patients with RA after multiple B-cell depletion cycles based on rituximab: relationship with B-cell kinetics. Rheumatology (Oxford) 2012; 51(5): 833–840.
28. Worch J, Makarova O, Burkhardt B. Immunreconstitution and infectious complications after rituximab treatment in children and adolescents: what do we know and what can we learn from adults? Cancers (Basel) 2015; 7(1): 305–328.
29. Irie E, Shirota Y, Suzuki C et al. Severe hypogammaglobulinemia persisting for 6 years after treatment with rituximab combined chemotherapy due to arrest of B lymphocyte differentiation together with alteration of T lymphocyte homeostasis. Int J Hematol 2010; 91(3): 501–508.
30. Walker AR, Kleiner A, Rich L et al. Profound hypogammaglobulinemia 7 years after treatment for indolent lymphoma. Cancer Invest 2008; 26(4): 431–433.
31. Shortt J, Spencer A. Adjuvant rituximab causes prolonged hypogammaglobulinaemia following autologous stem cell transplant for non-Hodgkin‘s lymphoma. Bone Marrow Transplant 2006; 38(6): 433–436.
32. Kelesidis T, Daikos G, Boumpas D et al. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 2011; 15(1): e2-e16. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijid.2010.03.025>.
33. Casulo C, Maragulia J, Zelenetz AD. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk 2013; 13(2): 106–111.
34. Furst DE. Serum immunoglobulins and risk of infection: how low can you go? Semin Arthritis Rheum 2009; 39(1): 18–29.
35. Roberts DM, Jones RB, Smith RM et al. Immunoglobulin G replacement for the treatment of infective complications of rituximab-associated hypogammaglobulinemia in autoimmune disease: A case series. J Autoimmun 2015; 57: 24–29.
36. Roberts DM, Jones RB, Smith RM et al. Rituximab-associated hypogammaglobulinemia: Incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun 2015; 57: 60–65.
37. Eijkhout HW, van der Meer JW, Kallenberg CG et al. The effect of two different dosages of intravenous immunoglobulin on the incidence of recurrent infections in patients with primary hypogammaglobulinemia. A randomized, double-blind, multicenter crossover trial. Ann Intern Med 2001; 135(3): 165–174.
38. Compagno N, Malipiero G, Cinetto F et al. Immunoglobulin replacement therapy in secondary hypogammaglobulinemia. Front Immunol 2014; 5: 626. Dostupné z DOI: <http://dx.doi.org/10.3389/fimmu.2014.00626>.
39. Compagno N, Cinetto F, Semenzato G et al. Subcutaneous immunoglobulin in lymphoproliferative disorders and rituximab-related secondary hypogammaglobulinemia: a single-center experience in 61 patients. Haematologica 2014; 99(6): 1101–1106.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2015 Číslo 9
Najčítanejšie v tomto čísle
- Therapeutic potential of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin in treatment chronic venous disorder
- Usefulness of vena cava filters from clinicians view
- Draft of the best medical treatment in patients with low-risk thyroid cancer
- Secondary humoral immunodeficiency in patiens with systemic lupus erythematosus