The Expanding Field of Secondary Antibody Deficiency: Causes, Diagnosis, and Management
- 1Department of Clinical Immunology, John Radcliffe Hospital, United Kingdom
- 2Departamento de Inmunología Clínica, Hospital General Universitario Gregorio Maranon, Spain
- 3Immunodeficiency Centre for Wales, Department of Immunology, University Hospital of Wales, United Kingdom
Antibody deficiency or hypogammaglobulinemia can have primary or secondary etiologies. Primary antibody deficiency (PAD) is the result of intrinsic genetic defects, whereas secondary antibody deficiency may arise as a consequence of underlying conditions or medication use. On a global level, malnutrition, HIV, and malaria are major causes of secondary immunodeficiency. In this review we consider secondary antibody deficiency, for which common causes include hematological malignancies, such as chronic lymphocytic leukemia or multiple myeloma, and their treatment, protein-losing states, and side effects of a number of immunosuppressive agents and procedures involved in solid organ transplantation. Secondary antibody deficiency is not only much more common than PAD, but is also being increasingly recognized with the wider and more prolonged use of a growing list of agents targeting B cells. SAD may thus present to a broad range of specialties and is associated with an increased risk of infection. Early diagnosis and intervention is key to avoiding morbidity and mortality. Optimizing treatment requires careful clinical and laboratory assessment and may involve close monitoring of risk parameters, vaccination, antibiotic strategies, and in some patients, immunoglobulin replacement therapy (IgRT). This review discusses the rapidly evolving list of underlying causes of secondary antibody deficiency, specifically focusing on therapies targeting B cells, alongside recent advances in screening, biomarkers of risk for the development of secondary antibody deficiency, diagnosis, monitoring, and management.
Keywords: secondary antibody deficiency, chronic lymphocytic leukaemia, Lymphoma, Multiple Myeloma, solid organ transplant
Received: 11 Jul 2018;
Accepted: 08 Jan 2019.
Edited by:Anne Puel, Institut National de la Santé et de la Recherche Médicale (INSERM), France
Reviewed by:Mike Recher, Universität Basel, Switzerland
John B. Ziegler, Sydney Children's Hospital, Australia
Copyright: © 2019 Patel, Carbone and Jolles. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Stephen Jolles, Immunodeficiency Centre for Wales, Department of Immunology, University Hospital of Wales, Cardiff, United Kingdom, JollesSR@cardiff.ac.uk