# Hypogammaglobulinaemia and infection risk after B-cell therapies

Source: https://onco.cc/terms/hypogammaglobulinaemia/  
OnCo record `hypogammaglobulinaemia` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A shortage of antibodies because treatment has wiped out the B cells or plasma cells that make them, as CD19 CAR-T, CD20 antibodies and BCMA therapies deliberately do. It leaves patients prone to infections, sometimes for years, and is managed with immunoglobulin infusions.

## Summary

Infections are the leading cause of non-relapse death after BCMA and CD19 CAR-T and bispecific antibodies; hypogammaglobulinaemia, prolonged cytopenias, T-cell dysfunction and steroids for CRS all contribute. Management includes IVIG for recurrent infections or IgG <4 g/L, prophylaxis against Pneumocystis, herpes viruses and sometimes fungi, CMV monitoring, and vaccination (non-live; responses are blunted, so household contacts should be vaccinated). Rituximab causes hypogammaglobulinaemia after repeated courses and hepatitis B reactivation. Persistent B-cell aplasia after CD19 CAR-T is also a useful sign that the CAR-T cells remain active.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: hypogammaglobulinemia; low immunoglobulins; low IgG; immunoglobulin replacement; IVIG; intravenous immunoglobulin; B-cell depletion; B-cell aplasia; infection risk; opportunistic infections; infection prophylaxis; antimicrobial prophylaxis; antiviral prophylaxis; PJP prophylaxis; Pneumocystis prophylaxis; CMV reactivation; cytomegalovirus; vaccine responses; revaccination

## Notes

- Lymphoma: Lymphoma Action says most people with lymphoma do not need immunoglobulin replacement, that preventive antibiotics are usually enough when antibody levels are low, and that replacement is likely only after severe or repeated infections requiring hospital admission despite those antibiotics. It names B-cell non-Hodgkin lymphoma, Hodgkin lymphoma, allogeneic transplant, engineered T-cell therapy and treatment that destroys or depletes B cells, such as rituximab, as the situations in which it arises. After engineered T-cell therapy, B cell levels are likely to be low for a long time, sometimes several years.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hypogammaglobulinemia
- Wikipedia: https://en.wikipedia.org/wiki/Hypogammaglobulinemia
- Lymphoma Action: immunoglobulin replacement therapy: https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/immunoglobulin-replacement-therapy
- Lymphoma Action: CAR-T cell therapy: https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/car-t-cell-therapy
- Lymphoma Action: infections, risk and prevention: https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/infections-risk-and-prevention

## Connected records

- terms: [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [Cytopenias and myelosuppression](https://onco.cc/terms/cytopenias/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Low antibodies and infection risk for years after anti-CD20 and bispecific antibodies](https://onco.cc/terms/lymphoma-living-infection-years-after/), [T-cell exhaustion and CAR-T persistence](https://onco.cc/terms/t-cell-exhaustion-term/), [Vaccinations around lymphoma treatment: the ones to have first, and the ones not to have at all](https://onco.cc/terms/lymphoma-living-vaccinations/)
- technologies: [After a transplant or cell therapy: what to ask for](https://onco.cc/technologies/rejuv-tx-what-to-ask-for/), [B-cell aplasia and low antibodies after CAR-T and bispecifics, and immunoglobulin replacement](https://onco.cc/technologies/rejuv-tx-b-cell-aplasia-and-immunoglobulin/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [Revaccination after transplant: the schedules, and where the UK and the US differ](https://onco.cc/technologies/rejuv-tx-revaccination/), [T-cell engagers (bispecific)](https://onco.cc/technologies/t-cell-engager/)
- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)](https://onco.cc/cancers/malt-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Nodal marginal zone lymphoma](https://onco.cc/cancers/nodal-marginal-zone-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Cell Therapy](https://onco.cc/fronts/cell-therapy/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Rituximab](https://onco.cc/drugs/rituximab/), [Teclistamab](https://onco.cc/drugs/teclistamab/)
- trials: [Inter-B-NHL Ritux 2010](https://onco.cc/trials/inter-b-nhl-ritux-2010/)

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