IgA and IgG Hypogammaglobulinemia Persists in Most Patients with Waldenstrom's Macroglobulinemia Despite Therapeutic Responses, Including Complete Remissions.

Abstract

Recurrent infections are common in pts with Waldenstrom's macroglobulinemia (WM) and may be related to IgA and IgG hypogammaglobulinemia. The impact of therapy and therapeutic responses on humoral immunity in WM is therefore of clinical interest. We examined IgA and IgG levels before and after therapy in 92 serially treated and responding WM patients. Their median age was 59 yrs and 70/92 (76.1%) were previously untreated. Median follow-up for all patients was 11 (range 3-134) months. Pre-therapy, 72/92 (78.2%) and 70/92 (76.1%), and post-therapy 82/92 (89.1%) and 80/92 (86.9%) pts demonstrated IgG (<700 mg/dL) and IgA (<70 mg/dL) hypogammaglobulinemia, respectively. Changes in median IgG and IgA levels by therapy were as follows:N=Pre-IgGPost-IgGT-TestPre-IgAPost-IgAT-TestNucleoside analogue54383990.6332380.35Rituximab174553580.2935290.43Rituximab/Thalidomide193883740.328240.32Rituximab/Nucleoside215714230.00655290.05CHOP37025680.6248300.82CHOP/Rituximab145373830.161360.21Chlorambucil ± steroids58376590.57129660.52Campath-1H75214440.6228270.61HD Dexamethasone1269173NA2728NAAll therapies924803980.00838280.01Changes in median IgG and IgA levels by response category were as follows:N=Pre-IgGPost-IgGT-TestPre-IgAPost-IgAT-TestCR86444720.0575370.08PR704153490.0927280.91MR144743940.0138260.02These studies demonstrate that IgA and IgG hypogammaglobulinemia persists despite therapeutic responses, including complete remissions in patients with WM. Futhermore, the therapeutic regimen employed may aggravate persistent IgA and IgG hypogammaglobulinemia.