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<p>Hypogammaglobulinemia is increasingly recognized in B-cell malignancies, but whether its clinical significance differs by timing, present at diagnosis versus developing after treatment, remains unclear in diffuse large B-cell lymphoma (DLBCL). We retrospectively evaluated 181 adults with newly diagnosed DLBCL treated with rituximab-based immunochemotherapy at a tertiary referral center. Hypogammaglobulinemia was defined as serum IgG &lt; 7&#xa0;g/L and classified as baseline hypogammaglobulinemia (BHG), treatment-emergent hypogammaglobulinemia (TEHG), or absent. Among the study population, 107 patients (59.1%) developed hypogammaglobulinemia, including 30 (16.6%) with BHG and 77 (42.5%) with TEHG. Patients with BHG exhibited a more adverse baseline clinical profile characterized by poorer performance status and higher-risk disease features. Complete response rates differed significantly across groups and were lowest in patients with BHG (73.3%) compared with TEHG (88.3%) and no hypogammaglobulinemia (94.6%) (<i>p</i> = 0.008). BHG was also associated with the poorest survival outcomes, with median progression-free survival (PFS) and overall survival (OS) of 26.4 and 30.9&#xa0;months, respectively. In multivariable analyses, BHG independently predicted infectious complications but was not an independent predictor of PFS. TEHG was associated with shorter PFS in the primary multivariable model; however, this association was not confirmed in a prespecified 6-month landmark analysis. These findings suggest that BHG and TEHG represent distinct clinical states in DLBCL. While BHG identifies a clinically vulnerable subgroup with increased infection risk and inferior outcomes, the prognostic significance of TEHG should be interpreted cautiously because of non-protocolized monitoring and potential ascertainment bias.</p>

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Distinct clinical associations of baseline and treatment-emergent hypogammaglobulinemia in diffuse large B-cell lymphoma: a retrospective real-world cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Utku Iltar,
  • Tugba Karacamli,
  • Sinem Oztekin,
  • Unal Atas,
  • Ece Vural,
  • Orhan Kemal Yucel,
  • Ozan Salim,
  • Levent Undar

摘要

Hypogammaglobulinemia is increasingly recognized in B-cell malignancies, but whether its clinical significance differs by timing, present at diagnosis versus developing after treatment, remains unclear in diffuse large B-cell lymphoma (DLBCL). We retrospectively evaluated 181 adults with newly diagnosed DLBCL treated with rituximab-based immunochemotherapy at a tertiary referral center. Hypogammaglobulinemia was defined as serum IgG < 7 g/L and classified as baseline hypogammaglobulinemia (BHG), treatment-emergent hypogammaglobulinemia (TEHG), or absent. Among the study population, 107 patients (59.1%) developed hypogammaglobulinemia, including 30 (16.6%) with BHG and 77 (42.5%) with TEHG. Patients with BHG exhibited a more adverse baseline clinical profile characterized by poorer performance status and higher-risk disease features. Complete response rates differed significantly across groups and were lowest in patients with BHG (73.3%) compared with TEHG (88.3%) and no hypogammaglobulinemia (94.6%) (p = 0.008). BHG was also associated with the poorest survival outcomes, with median progression-free survival (PFS) and overall survival (OS) of 26.4 and 30.9 months, respectively. In multivariable analyses, BHG independently predicted infectious complications but was not an independent predictor of PFS. TEHG was associated with shorter PFS in the primary multivariable model; however, this association was not confirmed in a prespecified 6-month landmark analysis. These findings suggest that BHG and TEHG represent distinct clinical states in DLBCL. While BHG identifies a clinically vulnerable subgroup with increased infection risk and inferior outcomes, the prognostic significance of TEHG should be interpreted cautiously because of non-protocolized monitoring and potential ascertainment bias.