Persistently Low IgG2 Levels in a Subset of Patients Following Hematopoietic Cell Transplantation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-10-22 DOI:10.1111/ctr.70010

Shigeo Fuji, Makiko Suga, Yuma Tada, Yasuhiro Shingai, Hidenori Kasahara, Sayako Yuda, Takafumi Yokota, Jun Ishikawa

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Abstract

Background

Infectious diseases remain a major cause of morbidity and mortality after hematopoietic cell transplantation (HCT). Secondary hypogammaglobulinemia is a risk factor for infectious diseases. Total immunoglobulin G (IgG) levels and the history of infectious diseases are an integral part of determining the indication for immunoglobulin replacement therapy. The clinical significance of IgG2 levels is not well established. Guidelines recommend using pathogen-specific IgG to evaluate patients with potential secondary immunodeficiency. However, it is difficult in practice to perform such testing. IgG2 may correlate well with pathogen-specific IgG but the clinical significance of IgG2 is not well established.

Methods

To assess the prevalence of low IgG2 levels with normal IgG after HCT, we cross-sectionally measured the levels of several immunoglobulins, including IgG, IgA, IgM, and IgG2, after HCT, and we assessed the correlation between them.

Results

Among 121 patients who underwent cross-sectional measurements of IgG, IgA, IgM, and IgG2 levels after HCT, 114 had normal IgG2 levels (normal IgG2 group, ≥ 100 mg/dL) and 7 had low IgG2 levels (low IgG2 group, < 100 mg/dL). These 7 patients were allogeneic HCT recipients. All 7 patients with low IgG2 had cGVHD and 4/7 patients had normal total IgG levels.

Conclusion

IgG2 levels may be low even in patients with normal IgG levels years after allogeneic HCT. Therefore, our study suggests that when patients develop infectious diseases, especially multiple episodes, it is recommended to measure IgG2 levels to exclude the possibility of secondary hypogammaglobulinemia after allogeneic HCT.

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造血细胞移植后部分患者的 IgG2 水平持续偏低。

背景：感染性疾病仍然是造血细胞移植（HCT）后发病和死亡的主要原因。继发性低丙种球蛋白血症是感染性疾病的一个危险因素。总免疫球蛋白 G (IgG) 水平和感染性疾病史是确定免疫球蛋白替代疗法适应症不可或缺的一部分。IgG2 水平的临床意义尚未明确。指南建议使用病原体特异性 IgG 来评估潜在的继发性免疫缺陷患者。但实际上很难进行这种检测。IgG2 可能与病原体特异性 IgG 有很好的相关性，但 IgG2 的临床意义尚未明确：为了评估 HCT 后低 IgG2 水平与正常 IgG 的发生率，我们横断面测量了 HCT 后几种免疫球蛋白（包括 IgG、IgA、IgM 和 IgG2）的水平，并评估了它们之间的相关性：在121例接受HCT后IgG、IgA、IgM和IgG2水平横断面测量的患者中，114例患者的IgG2水平正常（正常IgG2组，≥100 mg/dL），7例患者的IgG2水平较低（低IgG2组，<100 mg/dL）。这 7 名患者均为异基因 HCT 受者。所有7名IgG2水平较低的患者均发生了cGVHD，4/7患者的总IgG水平正常：结论：即使 IgG 水平正常的患者在接受异基因 HCT 多年后，IgG2 水平也可能偏低。因此，我们的研究表明，当患者出现感染性疾病，尤其是多次发作时，建议检测 IgG2 水平，以排除异基因 HCT 后继发性低丙种球蛋白血症的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.