Changes in the immune system of untreated patients with chronic lymphocytic leukaemia – part 1: adaptive immunity
Authors:
P. Vodárek; L. Smolej; D. Belada; M. Šimkovič; D. Écsiová; P. Žák
Authors‘ workplace:
IV. interní hematologická klinika LF UK a FN Hradec Králové
Published in:
Transfuze Hematol. dnes,27, 2021, No. 2, p. 128-136.
Category:
Review/Educational Papers
doi:
https://doi.org/10.48095/cctahd2021128
Overview
Chronic lymphocytic leukaemia, the most common leukaemia of adults in the western world, is associated with significant combined immunodeficiency. Even treatment-naive patients with early stages of the disease can have immunoglobulin deficiency. IgA hypogammaglobulinemia was shown to be a negative prognostic factor, leading to a higher frequency of bacterial infections. There are changes in both the number and immunophenotype of T-cells with inversion of the CD4+/ CD8+ ratio and an increase in regulatory T-cells. Changes in T-cell function are described as pseudo-exhaustion, characterised by the inability to form immunological synapses. Furthermore, the cytokine spectrum and immune cell differentiation indicate a shift towards Th2 immune response. These changes lead to increased susceptibility to opportunistic and viral infections. There are changes of innate immunity as well – NK cells, neutrophils, monocytes/ macrophages and the complement system are all affected. In this article, major adaptive immunity changes in treatment-naive patients are summarized.
Keywords:
chronic – lymphocytic – leukaemia – immunodeficiency – T-cells – cellular – B-cells – humoral – hypogammaglobulinemia –infections
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