IgA

[ava1967ir]

My IgA serum: 36 Normal level: 70-400

Is this dangerous?

[AussieNeil Partner Administrator]

You may be at higher risk of respiratory and gastro infections. Unfortunately there is nothing you can do to boost your IgA. IgG infusions can help to some degree, but you need to meet the criteria for those. (Serious infections and a sufficiently low IgG.) My IgA is currently around 15. It was last above your level two and a half years ago.

Neil

[ava1967ir in reply to AussieNeil]

Hi Neil and thanks for your reply,

In last blood test :

WBC:110.000. ALC:103000 Neutrofiles : 2%

Platelets :115000 Hb: 10.8 LDH : 295

Also, my spleen is enlarged

My IgG serum : 678. Normal level: 700-1600

IgA serum : 36 Normal level:. 70-400

IgM seum: 46. Normal level : 40-230

I’m still in w&w

[AussieNeil Partner Administrator in reply to ava1967ir]

For someone with CLL, I'd say your results are reasonable, though your LDH is on the high side and your haemoglobin lowish. (Your LDH might be higher than usual if your last blood test was difficult to take. It's trends we need to monitor.)

Don'r forget to calculate your absolute neutrophil count, which should be above 1,500 (or 1.5 elsewhere) to keep you reasonably safe from infection. Yours is 2% of 110,000 or 2.2.

My spleen has been enlarged for 10 years and I'm still in watch and wait. I started IgG infusions a year after my IgG dropped to half your count and some hospital admissions for IV antibiotics.

Finally, given you are using an identifiable picture - presumably of you, don't forget to lock your posts (or change your avatar image if you want your posts to help others searching for help). Here's how you lock your posts:

healthunlocked.com/cllsuppo...

Let me know if you need help.

Neil

[ava1967ir in reply to AussieNeil]

Thank you Neil, about my LDH :

LDH :295 Normal level: 230-460

And its amount has not changed much compared to previous blood tests.

Sorry my english is not good.

[AussieNeil Partner Administrator in reply to ava1967ir]

We have just shown the importance of providing the reference range for a blood test. There are at least two different measurement units for LD/LDH with two common reference ranges as follows:

1) 120 - 250

2) 310 - 620

unitslab.com/node/46

labtestsonline.org.au/learn...

I assumed you were high in the first reference range, whereas you are actually low in the second. By the way, low is generally a good result, as LDH is an independent measure of CLL tumour growth. A higher result can indicate a faster growth (lymphocyte doubling) rate.

Your English is absolutely fine!

[albie58 in reply to AussieNeil]

Neil,

I had all mine tested about three years ago. How often is IgG, IgA, and IgM tested? I'm on W & W and my results were/are very similiar to ava1967ir. If infections were to increase, would that trigger another test to see if they have decreased again? Thanks!

[AussieNeil Partner Administrator in reply to albie58]

The development of low Immunoglobulin counts (known as hypogammaglobulinemia) is fairly common in CLL, but it typically develops quite slowly. Mine were tested every 18 to 24 months until I needed IgG infusions, after which I needed more regularly testing to check the IgG infusions were adequately maintaining my IgG levels. They are now checked every 3 months.

[albie58 in reply to AussieNeil]

Thanks Neil! I appreciate the response.

[Panz]

Good morning to you! Welcome to our community!! I have much experience with all the Ig’s. I am very low in in all of them. IgG is 250; IgA is 3; IgM is <10 and IgD is zero and the don’t even test for it anymore. I am healthy as a horse. When I reached 400 IgG they wanted me to go on Ig infusion but because I was very healthy I put them off, however, one day I did get very ill and the IgG was 150 and my doctor told me I had no choice but to go on IgG infusions and so I did until I got to 400 and I wanted to stop and so I did. Then I got the Shingles and that is when I agreed to go on Gammagard infusion every four weeks and I now usually carry a 600+ IgG. All the other Ig’s just go along as they are as there is no way to infuse them. But as I said I am very healthy....I have had CLL for 30+ years and had treatment for 27 years. I occasionally need an iron infusion but not often only when the % iron saturation drops below 20. They do labs monthly. Hope this gives you a little insight and one thing you must remember we are all very different. All the very best to you!

☘️😍🙏💕

[ava1967ir in reply to Panz]

Thanks PANZ for your helpful information🌺

[Tortola2019]

There is a recent (2019) journal article regarding IgA levels being useful as a prognostic factor on time to treatment entitled:

"IgA hypogammaglobulinemia predicts outcome in chronic lymphocytic leukemia"

nature.com/articles/s41375-...

However, I haven't been able to read it as I don't have a subscription.

Marc

[ava1967ir in reply to Tortola2019]

Thank you but I can not read it like you😉

[70s-80s-overlander in reply to ava1967ir]

Here is a note I made some years ago. My memory about the whole article is that an ABRUPT drop in IgA was a bad sign.

IgA – low correlates with bad prognosis

[there are other articles, too, that speak of low IgA as correlating with more active disease]

Colovic N, Bogdanovic A, Martinovic V, Jankovic G.

Archive of Oncology 2001; 9(2): 79-82.

onk.ns.ac.rs/archive/Vol9/P...

“Prognostic significance of serum immunoglobulins in B- chronic lymphocytic leukemia”

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disorder of mature appearing B lymphocytes which are at the intermediate stage of differentiation. The disease is frequently accompanied by low levels of gamma globulins and different classes of immunoglobulins. In this study we analyzed the levels of immunoglobulins in different stages of B-CLL and its prognostic implication on survival.

METHODS: Between November 1999 and December 2000, 66 patients with CLL were treated at the Institute of Hematology. In this group of patients, 36 were males and 30 females, with median age of 61.2 year (range 37-75 years). Serum gammaglobulin level was quantitated by electrophoresis on cellulose acetate and photodensitometry. Serum immunoglobulins were quantitated by radial immunodiffusion using Immunoplates (Behring Institute, FRG).

RESULTS: According to Binet staging system 26(39.2%) were in stage A, 15 (22.6%) stage B and 25 (37.8%) patients in stage C. Low levels of immunoglobulins were found: IgG in 14 patients (21.2%), IgA in 21 (31%) and IgM in 16 patients (24.2%). At least one immunoglobulin was decreased in 77.2% patients.

CONCLUSION: The prolonged clinical course of B-CLL is usually complicated by hypogammaglobulinemia. Reduced survival was significantly influenced by low level of IgA (p=0.07). The intravenous administration of immunoglobulins could significantly contribute to the reduction of infection frequency and improvement in the quality of life.

[70s-80s-overlander in reply to Tortola2019]

"IgA hypogammaglobulinemia predicts outcome in chronic lymphocytic leukemia."

Gianluigi Reda et al. Leukemia 2018

semanticscholar.org/paper/I...

To the Editor, Reduction of serum immunoglobulins (Ig) is the most common immune defect in chronic lymphocytic leukemia (CLL) with an incidence at diagnosis of 20–60% according to previous studies. Hypogammaglobulinemia worsens during the course of the disease and is probably due to the defective functioning of the non-clonal, CD5-negative B cells [1, 2]. Over the last years, a number of prognostic scores have been developed to improve risk stratification [3, 4]. Recently, CLL-specific international prognostic index (CLL-IPI), that combines clinical and biological parameters, has been proposed [5]. Moreover, Delgado et al. [6, 7] have described a biological CLL-IPI that is able to identify populations with different outcomes, based on fluorescence in situ hybridization (FISH) analysis and IGHV mutational status only. To our knowledge, only few studies investigated the relationship among hypogammaglobulinemia and prognostic markers [1, 8–10]. In particular, a retrospective analysis of 159 patients showed a negative prognostic impact of low IgM levels on overall survival (OS) and time to first treatment (TTFT) [1]; moreover, low IgA levels were shown to impact on TTFT in a large series of Binet stage A, although multivariable analysis did not confirm this finding [10]. Here, we evaluated the impact of hypogammaglobulinemia on TTFT in 698 newly diagnosed CLL patients followed at Hematology Unit-Ospedale Maggiore Policlinico of Milan, from January 1983 till April 2016. We evaluated the relationship between hypogammaglobulinemia and prognostic parameters (IGHV, and high-risk cytogenetics by FISH). To strengthen the significance of our findings, we performed the same analysis on a monocentric independent series of 304 CLL patients. Table 1 shows the baseline demographic, clinical, and biological characteristics of all patients and those with available Ig levels (N= 410) from the original series (series 1). There was a slight male predominance (57.8%), median age was 64 years (range, 32–89), and 342 patients (84.2%) presented in Binet Stage A. FISH analysis, carried out in 286 (69.7%) patients, showed adverse cytogenetic abnormalities in 25 patients (8.7%—11q23 4.9% and 17p13 deletion in 3.8%). FISH analysis did not detect any abnormalities in 93 (32.5%) patients. One-hundred and fifty-four (68.8%) patients presented mutated IGHV status, 143 (72.6%) had ZAP70 negative, and 235 (75.3%) had CD38 negative. We observed reduced values of IgA in 71 patients (17.4%), IgG in 91 (22.2%), and IgM in 138 (33.7%). The reduction of at least one Ig class was found in 57%, of two classes in 33%, and of all classes in 7.8% of patients, respectively. Hypogammaglobulinemia of any class significantly correlated with advanced disease (Rai III–IV and Binet B–C; Table 1S). Focusing on the relationship with adverse prognostic markers, IgA deficit emerged as the only significant factor. In particular, patients with unmutated IGHV status * G. Reda [e-mail]

[Tortola2019 in reply to 70s-80s-overlander]

Thank you for providing the info from article in question. It frustrates me not being able to get the information easily (because I know longer work at a university .)

Marc

[Panz]

I was abl to read it but it warps so far over my head...I got nothing from it at all...usually I am able to gleam something but not this article. 😍☘️💕🙏