Hypogammaglobulinemia is a condition that can affect people who have lymphoma. Our B-cell lymphocytes make antibodies (also called immunoglobulins) which help to fight infection and disease.
Cancers of B-cell lymphocytes, such as B-cell lymphoma, as well as treatments for lymphoma can result in low antibody levels in your blood. This is called hypogammaglobulinemia and can result in you being more prone to infections or you may have trouble getting rid of infections.
For some people, hypogammaglobulinemia is a temporary condition, while others may need long-term immune support. Ask your doctor how long you will need extra immune support.
A medical term used to describe low antibody levels in your blood.
What are antibodies?
Antibodies are a type of protein made by our B-cell lymphocytes to fight and eliminate infection and disease (pathogens). We have different types of antibodies and each one only fights a specific type of pathogen. Click on the headings below to learn more about the different types of antibodies.
Immunoglobulin Gamma
We have more IgG antibodies than any other antibody. They are shaped like the letter Y .Â
IgG is found mostly in our blood and other body fluids. These proteins have an immunological memory, so they remember the infections you had in the past and can identify them easily in the future.Â
Each time we have an illness we store some specialised memory IgG in our blood to protect us in the future.
If you do not have enough healthy IgG, you may get more infections or have difficulty getting rid of infections.
Immunoglobulin Alpha (IgA)
IgA is an antibody found mostly in our mucous membranes that line our gut and respiratory tract. Some IgA can also be in our saliva, tears and in breastmilk.
IgM is the largest antibody we have and looks like 5 “Y”s together in the shape of a wagon wheel. It is the first antibody on site when we have an infection, so your level of IgM can increase during an infection, but then goes back to normal once the IgG or other antibodies are activated.
Low levels of IgM can lead to you getting more infections than usual.Â
Immunoglobulin Epsilon (IgE)
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Immunoglobulin Delta (IgD)
IgD is one of the least understood antibodies. However, what is known is that it is produced by plasma cells, and is usually found attached to other mature B-cell lymphocytes in our spleen, lymph nodes, tonsils and the lining of our mouth and airways (mucous membranes).
Plasma cells are the most mature form of B-cell lymphocytes.
A small amount of IgD can also be found in our blood, lungs, airways, tear ducts and middle ear. IgD is thought to encourage mature B-cell lymphocytes to become plasma cells. It is thought to be important at preventing respiratory infections.
IgD is often found together with IgM, however it is not clear on how or if they work together.
Symptoms of hypogammaglobulinemia
Symptoms of hypogammaglobulinemia are related to your weakened immune system and infections you get as a result.
Common symptoms of hypogammaglobulinemia include:
- Repeated respiratory infections such as flu, colds, bronchitis, pneumonia, COVID.
- Infections in your gastrointestinal tract (stomach and bowels) resulting in stomach cramps, diarrhea or foul-smelling wind or poo.
- Unusual infections
- Difficulty getting over infections.
- High temperature (fever) of 38 degrees or more.
- Chills and rigors (shaking)
Causes of hypogammaglobulinemia
Hypogammaglobulinemia can be a genetic condition you are born with due to mutations in your genes, or it can be a secondary condition. This webpage is about secondary hypogammaglobulinemia as it is a side-effect of treatment rather than a condition you are born with.
Having a cancer of your B-cell lymphocytes (such as a B-cell lymphoma) increases your risk of hypogammaglobulinemia because it is the B-cell lymphocytes that make our antibodies. Other causes can include:
- Chemotherapy
- Monoclonal antibodies
- Targeted therapies such as BTK or BCL2 inhibitors
- Radiation treatment to your bones or bone marrow
- Corticosteroids
- Cellular therapies such as Stem-cell transplant or CAR T-cell therapy
- Poor nutrition
Treatment of hypogammaglobulinemia
Treatment of hypogammaglobulinemia is aimed at preventing or treating any infection before they become life threatening.Â
Your haematologist or oncologist might start you on some prophylactic medicine. Prophylactic means preventative. These are given even if you don’t have an infection, to try and stop you getting sick later, or lessen your symptoms if you do get sick.
Some types of medicine you might be started on include:
- Intravenous immunoglobulin (IVIG). This can be given as an infusion straight into your blood stream, or as in injection into your tummy. It is filled with immunoglobulins from a donor to help boost your own immunoglobulin (antibody) levels.
- Anti-fungal medicine such as fluconazole or posaconazole. These prevent or treat fungal infections such as thrush that you can get in your mouth or genitals
- Anti-viral medicine such as valacyclovir. These prevent a flare up or treat viral infections such as herpes simplex virus (HSV), which causes cold sores on your mouth or sores on your genitals.
- Anti-bacterial medicine such as trimethoprim. These prevent certain bacterial infections such as bacterial pneumonia.
Signs of infection
Signs of infection can include:
- Fever or temperature of 38° degrees or more
- Chills and/or rigors (uncontrolled shivering)
- Pain and redness around wounds
- Pus or discharge from a wound
- Cough or sore throat
- Difficulty breathing
- Coated tongue that is not improved after brushing
- Sores in your mouth that are painful and red or inflammed (swollen)
- Difficulty, pain or burning going to the toilet
- Feeling generally unwell
- Low blood pressure or fast heartbeat.
Treating infection
If you have an infection, you will be given medicine to help overcome the infection. This could include antibiotics, more antifungals or antiviral medications depending on the type of infection you have. You may need to be admitted to hospital to have these medicines.
If you become unwell, or have signs of infection, contact your doctor immediately. If you cannot get hold of your doctor, phone an ambulance on "000" or go to your nearest emergency department.
Summary
- Hypogammaglobulinemia is a medical word used to for having low antibody levels in your blood.
- Antibodies are also called immunoglobulins and are a protein made by B-cell lymphocyte.
- Immunoglobulins are a major part of our immune system and fight infection, disease and help eliminate them from our body.
- Low antibody levels can result in your gettting repeated infections, or having difficulty getting over infections.
- B-cell lymphomas, and treatments for lymphoma can cause hypogammaglobulinemia.
- You may need extra immune support to protect you from infection and disease. This may include receiving immunoglobulins from donor or prophylactic anti-fungal, anti-viral medicines or antibiotics.
- Hypogammaglobulinemia may be a short term condition or need long-term management. Ask your doctor what to expect.
- If you have any questions, contact our Lymphoma Care Nurses by clicking on the contact us button on the bottom of the screen.
