Abstract
Objective: The aim of this study was to identify pitfalls in establishing the diagnosis of celiac disease (CD) in patients with a history of lymphoma. Methods: A total of 103 patients with a history of lymphoma had anti-tissue transglutaminase antibodies (atTGA) and their class A, G, and M immunoglobulin (IgA, IgG) levels determined.
Patients with atTGA positivity underwent enterobiopsy and CD-associated HLA locus testing. Results: The mean age of patients was 55 ( ± 13.5) years.
The predominant lymphoma types included B-type nonHodgkin’s lymphoma (B-NHL, 66 %), T-type NHL (8 %), and Hodgkin’s lymphoma (26 %). Serological positivity was documented in 3.9 % of cases; one patient had the diagnosis of CD confirmed by enterobiopsy.
In 11 patients (10.7 %), IgA levels were decreased to a various extent; of these patients, 10 were shown to have also their IgG levels decreased. The median time from follow-up to blood collection was 58 (32-104) months.
The decrease in immunoglobulin levels correlated with a more advanced stage of the tumor (Ann Arbor III–IV) at the time of diagnosis [1.4 (0.9–2.0) g/l versus 2.4 (1.5–3.0) g/l for IgA, p = 0.0001; and 9.4 (7.2–11.5) g/l versus 11.2 (10.3–12.3) g/l for IgG, p = 0.001] and older age [65 (54–72) years versus 55 (44–61) years for IgA, p = 0.04; and 69 (59–74) years versus 53 (43–61) years for IgG, p = 0.0001]. Rituximab therapy in B-NHL patients had no effect on the subsequent incidence of decreased IgA levels.
Conclusion: Reduced IgA and IgG levels represent important factors contributing to the low detection rate of serological screening for CD in patients with a history of lymphoma.