Memorial Sloan Kettering Cancer Center, New York, NY, USA.
A. C. Camargo Cancer Center, São Paulo, Brazil.
Leuk Lymphoma. 2022 Mar;63(3):573-582. doi: 10.1080/10428194.2021.2010058. Epub 2022 Feb 3.
Although treatment with anti-CD20 monoclonal antibodies (mAb) has improved outcomes in B-cell malignancies, it's associated with increased risk of hypogammaglobulinemia (HG). Our study aimed to determine the effects of anti-CD20 mAb on serum immunoglobulins (Ig) in follicular lymphoma (FL). Ig concentrations, infectious complications, and need for intravenous Ig were evaluated by level of exposure to anti-CD20 mAb in 380 patients. Prevalence of HG significantly differed by level of treatment exposure ( < 0.001). Single course anti-CD20 mAb was associated with rising IgG (+10.3 mg/dL/year), whereas the addition of maintenance therapy (-7.4 mg/dL/year) or multiple courses of treatment (-10.3 mg/dL/year) was associated with declining IgG. Among patients treated with anti-CD20 mAb, 45.2% developed IgG-HG and 10.3% developed symptomatic IgG-HG. Pretreatment IgG levels gradually declined in all patients, suggesting tumor burden may contribute to HG. Baseline and periodic monitoring of serum Ig is appropriate in patients with FL, including those managed with active surveillance.
虽然抗 CD20 单克隆抗体 (mAb) 的治疗改善了 B 细胞恶性肿瘤的预后，但它与低丙种球蛋白血症 (HG) 的风险增加有关。我们的研究旨在确定抗 CD20 mAb 对滤泡淋巴瘤 (FL) 患者血清免疫球蛋白 (Ig) 的影响。通过评估 380 名患者抗 CD20 mAb 暴露水平，评估了 Ig 浓度、感染并发症和静脉注射免疫球蛋白 (Ig) 的需求。HG 的患病率因治疗暴露水平的不同而显著不同（<0.001）。单次抗 CD20 mAb 治疗与 IgG 升高（+10.3mg/dL/年）相关，而维持治疗的加入（-7.4mg/dL/年）或多次治疗（-10.3mg/dL/年）与 IgG 下降相关。在接受抗 CD20 mAb 治疗的患者中，45.2%发生 IgG-HG，10.3%发生有症状的 IgG-HG。所有患者的 IgG 水平逐渐下降，提示肿瘤负荷可能导致 HG。包括接受主动监测的患者在内，FL 患者均应进行血清 Ig 的基线和定期监测。
