Should mild hypogammaglobulinemia be managed as severe hypogammaglobulinemia? A study of 389 patients with secondary hypogammaglobulinemia

•Secondary hypogammaglobulinemia is a frequent condition.•Mild hypogammaglobulinemia (5–6.4 g/L) does not meet the classical criteria (< 5 g/L).•Etiologies and infections are similar between mild and severe hypogammaglobulinemia.•Vaccination coverage against pneumococcus is low in mild hypogammaglobulinemia.•Mild hypogammaglobulinemia requires confirmation, investigation and vaccination.

BackgroundAlthough secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia.MethodsThis retrospective observational study included all adult patients with a gammaglobulin level < 6.4 g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin < 5 g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin < 6.4 and ≥ 5 g/L, mild hypogammaglobulinemia).ResultsAmong the 4011 serum electrophoreses, 570 samples from 389 patients had gammaglobulin levels below 6.4 g/L: 156 (40%) in group 1 and 233 (60%) in group 2. Mean age ± SD was 67 (15) years, and sex ratio was 1.04 (M/F) with no difference between the two groups. An etiology was identified in 79% and 58% of patients in groups 1 and 2, respectively (p < 0.0001). The main etiologies were similar in both groups and included malignant hemopathy treated with cytostatic agents (n = 129, 33%), smoldering or newly-diagnosed hemopathy without treatment (n = 49, 13%) and immunosuppressive treatment (n = 91, 23%). The incidence of hypogammaglobulinemia-related infections was 22/100/year, with no significant difference between the two groups (p = 0.17). Vaccination coverage against pneumococcus was 33%, and higher in group 1 (46% vs. 24%; p < 0.0001). When no cause was known at inclusion, an etiology was discovered in 22/130 patients (17%), 11 in each group.ConclusionsThough mild hypogammaglobulinemia does not meet the classical criteria for hypogammaglobulinemia (< 5 g/L), the etiology and infectious risk are similar. It therefore requires investigation and vaccination.