Clinical and laboratory characteristics of patients with symptomatic secondary immunodeficiency following the treatment of haematological malignancies

Adrian M Shields*, Sian E Faustini, Siobhan Young, Sarah Terjesen, Nicholas I McCarthy, Rachel L Anderson, Mark T Drayson, Alex G Richter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

62 Downloads (Pure)

Abstract

Secondary immunodeficiency (SID), manifesting as increased susceptibility to infection, is an emergent clinical problem in haematoncology. Management of SID includes vaccination, prophylactic antibiotics (pAbx) and immunoglobulin replacement therapy (IgRT). We report clinical and laboratory parameters of 75 individuals, treated for haematological malignancy, who were referred for immunological assessment due to recurrent infections. Forty-five were managed with pAbx while thirty required IgRT after failing to improve on pAbx. Individuals requiring IgRT had significantly more bacterial, viral and fungal infections resulting in hospitalization at least 5 years after their original haemato-oncological diagnosis. Following immunological assessment and intervention, a 4.39-fold reduction in the frequency of hospital admissions to treat infection was observed in the IgRT cohort and a 2.30-fold reduction in the pAbx cohort. Significant reductions in outpatient antibiotic use were also observed in both cohorts following immunology input. Patients requiring IgRT were more hypogammaglobulinaemic and had lower titres of pathogen-specific antibodies and smaller memory B cell populations than those requiring pAbx. Test vaccination with pneumococcal conjugate vaccine discriminated poorly between the two groups. Patients requiring IgRT could be distinguished by combining wider pathogen-specific serology with a frequency of hospital admissions for infection. If validated in larger cohorts, this approach may circumvent the need for test vaccination and enhance patient selection for IgRT.

Original languageEnglish
Pages (from-to)339-349
Number of pages11
JournalEJHaem
Volume4
Issue number2
Early online date1 Apr 2023
DOIs
Publication statusPublished - 16 May 2023

Bibliographical note

© 2023 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.

Keywords

  • haematological malignancy
  • immunoglobulin replacement
  • secondary immunodeficiency
  • vaccination

Fingerprint

Dive into the research topics of 'Clinical and laboratory characteristics of patients with symptomatic secondary immunodeficiency following the treatment of haematological malignancies'. Together they form a unique fingerprint.

Cite this