[CIS PIDD] [cis-pidd] Hypogammaglobulinemia and light chain deposition in kidneys

[Seppänen Mikko]

In about 10-15 patients within the last 8 years, our experience is the same as Prescott's. 

Mikko Seppänen, Helsinki

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Lähettäjä: Prescott Atkinson, M.D. [PAtkinson at peds.uab.edu]
Lähetetty: 3. heinäkuuta 2014 1:42
Vastaanottaja: CIS-PIDD
Aihe: RE: [cis-pidd] Hypogammaglobulinemia and light chain deposition in kidneys

I’ve turned up several CLL patients during the course of evaluation and have never seen any such reactions to immunization or heard of such a problem.  The first patient sounds like pretty aggressive behavior for CLL – wonder if it was just a coincidence that she worsened acutely around the time of immunization.

Prescott Atkinson

University of Alabama at Birmingham
From: Anastasiya Ashurova [mailto:ana.ashurova at gmail.com]
Sent: Wednesday, July 02, 2014 5:14 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Hypogammaglobulinemia and light chain deposition in kidneys

We would like to elicit your opinion on a case we saw in our office.  An adult patient presented to our office for immune workup in the setting of frequent upper respiratory infections,  IgG of 679mg/dL, non protective diphtheria and pneumococcal titers and most notably CD19 of 1573.  She was subsequently vaccinated with Pneumovax 23 and Td and returned two months later with a large mass over the site of her Td vaccination (left arm) and diffuse lymphadenopathy.  Biopsy of both an axillary lymph node and mass was positive for small lymphocytic lymphoma/CLL.
We now have a patient in our office with CLL, CD19 of 13000 in need of Pneumovax.  What has been your experience in vaccination patients with elevated B cell counts? Has anyone observed “unmasking” or worsening of a lymphoproliferative disorder after immunization?

Thank you,
 Anastasiya Kleva
Fellow, Steven & Alexandra Cohen Children’s Medical Center.




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