Rationale

The correlation between cytopenias and infection, malignancy, and mortality has not been systematically characterized in patients with inborn errors of immunity (IEIs).

Methods

We evaluated the association between anemia, thrombocytopenia, lymphopenia, and neutropenia and infection, malignancy, and mortality rates in IEI patients enrolled in the United States Immunodeficiency Network (USIDNET) registry.

Results

Of the 4,005 IEI patients enrolled in the USIDNET cohort through April 2019, we excluded 438 patients due to prior solid organ or hematopoietic stem cell transplantation. In the final cohort (n = 3,657), the median age of participants was 27 (IQR 16-50) years. Approximately 47.9% of participants were female. The majority of patients (57.2%) were classified as predominantly antibody deficiencies per the International Union of Immunological Societies (IUIS) categorization with common variable immunodeficiency being the most common diagnosis (38.9%). A total of 1,093 (29.9%) patients had one or more cytopenias, including 656 (17.9%) with anemia, 481 (13.2%) with thrombocytopenia, 323 (8.8%) with lymphopenia, and 336 (9.2%) with neutropenia. Approximately 274 (7.5%) of patients had immune-mediated cytopenias. Patients with cytopenias exhibited higher odds of infection (OR = 4.00, 95% CI 3.07-5.28), malignancy (OR = 2.51, 95% CI 1.93-3.25), and mortality (OR = 2.81, 95% CI 2.01-3.92) as compared with patients without cytopenias. Neutropenic patients frequently developed bacterial infections (58.6%), followed by viral (51.5%), fungal (35.4%), and parasitic (5.1%). Our cohort also demonstrated a high rate of sinopulmonary infections (75.8%) and skin and soft tissue infections (31.9%).

Conclusions

Cytopenias are a common manifestation across various IEIs. Patients with cytopenias exhibited a heightened risk of infection, malignancy, and mortality, highlighting underlying immune dysregulation and calling for the need to address cytopenias in the management of IEIs.

Table 1.

Cytopenias in primary immunodeficiencies and IUIS categories

Immunodeficiency# Thrombocytopenia# Anemia# Neutropenia# Lymphopenia# Any cytopeniaTotal count (N = 3511)
Agammaglobulinemia 10 (4%) 25 (10%) 23 (9%) 3 (1%) 45 (18%) 257 
Ataxia telangiectasia 6 (23%) 6 (23%) 2 (8%) 7 (27%) 11 (42%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 14 (22%) 29 (45%) 9 (14%) 7 (11%) 34 (53%) 64 
Autoinflammatory disease 1 (8%) 0 (0%) 1 (8%) 0 (0%) 2 (17%) 12 
CHARGE syndrome 0 (0%) 0 (0%) 0 (0%) 1 (33%) 1 (33%) 
Chronic granulomatous disease 9 (6%) 45 (31%) 3 (2%) 0 (0%) 51 (35%) 145 
Combined immune deficiency 9 (17%) 11 (21%) 10 (19%) 16 (31%) 22 (42%) 52 
Common variable immune deficiency (CVID) 210 (15%) 259 (18%) 86 (6%) 79 (6%) 416 (29%) 1416 
Complement deficiency 1 (4%) 2 (8%) 0 (0%) 0 (0%) 2 (8%) 26 
DiGeorge syndrome 20 (4%) 16 (3%) 7 (1%) 41 (8%) 63 (13%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 1 (100%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 0 (0%) 5 (21%) 2 (8%) 3 (12%) 8 (33%) 24 
HLH, including XLP and pigmentary disorders 5 (31%) 5 (31%) 4 (25%) 4 (25%) 8 (50%) 16 
Hyper IgE syndrome 3 (3%) 14 (15%) 3 (3%) 0 (0%) 18 (19%) 96 
Hyper IgM syndrome 1 (2%) 4 (9%) 18 (38%) 1 (2%) 19 (40%) 47 
Hypogammaglobulinemia 11 (5%) 21 (10%) 10 (5%) 10 (5%) 35 (17%) 209 
IgA deficiency 1 (1%) 2 (3%) 2 (3%) 7 (10%) 11 (16%) 68 
IgG subclass deficiency 1 (4%) 3 (12%) 1 (4%) 0 (0%) 6 (23%) 26 
Immune deficiency with syndromic features (not otherwise listed) 0 (0%) 1 (12%) 0 (0%) 0 (0%) 1 (12%) 
Immune dysregulation 22 (29%) 25 (33%) 17 (23%) 18 (24%) 40 (53%) 75 
Immunodeficiency unknown cause 3 (16%) 4 (21%) 2 (11%) 2 (11%) 5 (26%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 9 (33%) 11 (41%) 8 (30%) 9 (33%) 14 (52%) 27 
Interferonopathy (Aicardi-Goutières and others) 0 (0%) 2 (29%) 0 (0%) 0 (0%) 4 (57%) 
Leukocyte adhesion deficiency 0 (0%) 3 (33%) 0 (0%) 0 (0%) 3 (33%) 
Mucocutaneous candidiasis 0 (0%) 5 (12%) 1 (2%) 1 (2%) 7 (16%) 43 
Neutropenia 0 (0%) 0 (0%) 2 (100%) 0 (0%) 2 (100%) 
NK cell defect 1 (25%) 0 (0%) 1 (25%) 0 (0%) 2 (50%) 
Omenn syndrome 0 (0%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 
Other immune deficiency - known cause 3 (6%) 7 (13%) 2 (4%) 0 (0%) 9 (17%) 54 
Other T-cell problems 1 (14%) 1 (14%) 0 (0%) 1 (14%) 2 (29%) 
Predisposition to severe viral infections 6 (20%) 12 (40%) 23 (77%) 1 (3%) 24 (80%) 30 
Severe combined immune deficiency (SCID) 3 (5%) 11 (17%) 8 (12%) 16 (24%) 22 (33%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 4 (4%) 12 (12%) 2 (2%) 4 (4%) 18 (19%) 97 
Susceptibility to mycobacteria (MSMD) 0 (0%) 1 (12%) 0 (0%) 0 (0%) 1 (12%) 
TLR pathway abnormality 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 0 (0%) 0 (0%) 1 (7%) 0 (0%) 1 (7%) 14 
Wiskott-Aldrich syndrome 35 (65%) 13 (24%) 3 (6%) 3 (6%) 38 (70%) 54 
Immunodeficiency# Thrombocytopenia# Anemia# Neutropenia# Lymphopenia# Any cytopeniaTotal count (N = 3511)
Agammaglobulinemia 10 (4%) 25 (10%) 23 (9%) 3 (1%) 45 (18%) 257 
Ataxia telangiectasia 6 (23%) 6 (23%) 2 (8%) 7 (27%) 11 (42%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 14 (22%) 29 (45%) 9 (14%) 7 (11%) 34 (53%) 64 
Autoinflammatory disease 1 (8%) 0 (0%) 1 (8%) 0 (0%) 2 (17%) 12 
CHARGE syndrome 0 (0%) 0 (0%) 0 (0%) 1 (33%) 1 (33%) 
Chronic granulomatous disease 9 (6%) 45 (31%) 3 (2%) 0 (0%) 51 (35%) 145 
Combined immune deficiency 9 (17%) 11 (21%) 10 (19%) 16 (31%) 22 (42%) 52 
Common variable immune deficiency (CVID) 210 (15%) 259 (18%) 86 (6%) 79 (6%) 416 (29%) 1416 
Complement deficiency 1 (4%) 2 (8%) 0 (0%) 0 (0%) 2 (8%) 26 
DiGeorge syndrome 20 (4%) 16 (3%) 7 (1%) 41 (8%) 63 (13%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 1 (100%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 0 (0%) 5 (21%) 2 (8%) 3 (12%) 8 (33%) 24 
HLH, including XLP and pigmentary disorders 5 (31%) 5 (31%) 4 (25%) 4 (25%) 8 (50%) 16 
Hyper IgE syndrome 3 (3%) 14 (15%) 3 (3%) 0 (0%) 18 (19%) 96 
Hyper IgM syndrome 1 (2%) 4 (9%) 18 (38%) 1 (2%) 19 (40%) 47 
Hypogammaglobulinemia 11 (5%) 21 (10%) 10 (5%) 10 (5%) 35 (17%) 209 
IgA deficiency 1 (1%) 2 (3%) 2 (3%) 7 (10%) 11 (16%) 68 
IgG subclass deficiency 1 (4%) 3 (12%) 1 (4%) 0 (0%) 6 (23%) 26 
Immune deficiency with syndromic features (not otherwise listed) 0 (0%) 1 (12%) 0 (0%) 0 (0%) 1 (12%) 
Immune dysregulation 22 (29%) 25 (33%) 17 (23%) 18 (24%) 40 (53%) 75 
Immunodeficiency unknown cause 3 (16%) 4 (21%) 2 (11%) 2 (11%) 5 (26%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 9 (33%) 11 (41%) 8 (30%) 9 (33%) 14 (52%) 27 
Interferonopathy (Aicardi-Goutières and others) 0 (0%) 2 (29%) 0 (0%) 0 (0%) 4 (57%) 
Leukocyte adhesion deficiency 0 (0%) 3 (33%) 0 (0%) 0 (0%) 3 (33%) 
Mucocutaneous candidiasis 0 (0%) 5 (12%) 1 (2%) 1 (2%) 7 (16%) 43 
Neutropenia 0 (0%) 0 (0%) 2 (100%) 0 (0%) 2 (100%) 
NK cell defect 1 (25%) 0 (0%) 1 (25%) 0 (0%) 2 (50%) 
Omenn syndrome 0 (0%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 
Other immune deficiency - known cause 3 (6%) 7 (13%) 2 (4%) 0 (0%) 9 (17%) 54 
Other T-cell problems 1 (14%) 1 (14%) 0 (0%) 1 (14%) 2 (29%) 
Predisposition to severe viral infections 6 (20%) 12 (40%) 23 (77%) 1 (3%) 24 (80%) 30 
Severe combined immune deficiency (SCID) 3 (5%) 11 (17%) 8 (12%) 16 (24%) 22 (33%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 4 (4%) 12 (12%) 2 (2%) 4 (4%) 18 (19%) 97 
Susceptibility to mycobacteria (MSMD) 0 (0%) 1 (12%) 0 (0%) 0 (0%) 1 (12%) 
TLR pathway abnormality 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 0 (0%) 0 (0%) 1 (7%) 0 (0%) 1 (7%) 14 
Wiskott-Aldrich syndrome 35 (65%) 13 (24%) 3 (6%) 3 (6%) 38 (70%) 54 
Table 2.

Sites of infection in IEI

ImmunodeficiencyUrogenitalSSTISino-pulmonaryCardiacOdontogenicOphthalmicMSKCNSGIBloodstreamAny siteTotal count (N = 3511)
Agammaglobulinemia 18 (7%) 92 (36%) 221 (86%) 0 (0%) 1 (0%) 67 (26%) 25 (10%) 34 (13%) 66 (26%) 29 (11%) 235 (91%) 257 
Ataxia telangiectasia 1 (4%) 3 (12%) 21 (81%) 0 (0%) 0 (0%) 2 (8%) 1 (4%) 1 (4%) 8 (31%) 3 (12%) 24 (92%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 9 (14%) 32 (50%) 33 (52%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 2 (3%) 16 (25%) 9 (14%) 54 (84%) 64 
Autoinflammatory disease 1 (8%) 3 (25%) 5 (42%) 0 (0%) 0 (0%) 2 (17%) 0 (0%) 1 (8%) 1 (8%) 0 (0%) 9 (75%) 12 
CHARGE syndrome 1 (33%) 1 (33%) 2 (67%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (67%) 3 (100%) 
Chronic granulomatous disease 13 (9%) 115 (79%) 123 (85%) 0 (0%) 5 (3%) 8 (6%) 17 (12%) 14 (10%) 75 (52%) 15 (10%) 143 (99%) 145 
Combined immune deficiency 5 (10%) 25 (48%) 40 (77%) 1 (2%) 0 (0%) 11 (21%) 3 (6%) 5 (10%) 12 (23%) 12 (23%) 43 (83%) 52 
Common variable immune deficiency (CVID) 242 (17%) 381 (27%) 1211 (86%) 4 (0%) 18 (1%) 126 (9%) 32 (2%) 62 (4%) 248 (18%) 91 (6%) 1265 (89%) 1416 
Complement deficiency 1 (4%) 9 (35%) 21 (81%) 0 (0%) 0 (0%) 1 (4%) 2 (8%) 7 (27%) 3 (12%) 6 (23%) 23 (88%) 26 
DiGeorge syndrome 22 (4%) 34 (7%) 157 (32%) 7 (1%) 0 (0%) 11 (2%) 2 (0%) 1 (0%) 11 (2%) 19 (4%) 171 (34%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 1 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 2 (8%) 16 (67%) 18 (75%) 0 (0%) 0 (0%) 1 (4%) 1 (4%) 8 (33%) 8 (33%) 5 (21%) 24 (100%) 24 
HLH, including XLP and pigmentary disorders 2 (12%) 5 (31%) 12 (75%) 0 (0%) 0 (0%) 1 (6%) 0 (0%) 1 (6%) 3 (19%) 2 (12%) 13 (81%) 16 
Hyper IgE syndrome 18 (19%) 84 (88%) 88 (92%) 1 (1%) 3 (3%) 4 (4%) 7 (7%) 5 (5%) 19 (20%) 7 (7%) 91 (95%) 96 
Hyper IgM syndrome 3 (6%) 12 (26%) 43 (91%) 0 (0%) 1 (2%) 4 (9%) 0 (0%) 3 (6%) 11 (23%) 5 (11%) 44 (94%) 47 
Hypogammaglobulinemia 34 (16%) 56 (27%) 162 (78%) 0 (0%) 2 (1%) 10 (5%) 3 (1%) 1 (0%) 23 (11%) 6 (3%) 173 (83%) 209 
IgA deficiency 8 (12%) 15 (22%) 63 (93%) 0 (0%) 0 (0%) 4 (6%) 1 (1%) 3 (4%) 16 (24%) 1 (1%) 66 (97%) 68 
IgG subclass deficiency 7 (27%) 6 (23%) 25 (96%) 0 (0%) 2 (8%) 1 (4%) 1 (4%) 1 (4%) 2 (8%) 0 (0%) 25 (96%) 26 
Immune deficiency with syndromic features (not otherwise listed) 4 (50%) 3 (38%) 6 (75%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (12%) 1 (12%) 8 (100%) 
Immune dysregulation 15 (20%) 40 (53%) 66 (88%) 1 (1%) 5 (7%) 9 (12%) 1 (1%) 5 (7%) 20 (27%) 9 (12%) 69 (92%) 75 
Immunodeficiency unknown cause 2 (11%) 5 (26%) 12 (63%) 2 (11%) 0 (0%) 0 (0%) 1 (5%) 2 (11%) 3 (16%) 1 (5%) 16 (84%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 7 (26%) 14 (52%) 16 (59%) 1 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 3 (11%) 1 (4%) 22 (81%) 27 
Interferonopathy (Aicardi-Goutières and others) 0 (0%) 2 (29%) 3 (43%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (14%) 0 (0%) 1 (14%) 4 (57%) 
Leukocyte adhesion deficiency 3 (33%) 9 (100%) 8 (89%) 1 (11%) 2 (22%) 2 (22%) 1 (11%) 0 (0%) 4 (44%) 1 (11%) 9 (100%) 
Mucocutaneous candidiasis 10 (23%) 37 (86%) 32 (74%) 1 (2%) 0 (0%) 3 (7%) 3 (7%) 3 (7%) 11 (26%) 4 (9%) 42 (98%) 43 
Neutropenia 0 (0%) 0 (0%) 2 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (100%) 
NK cell defect 1 (25%) 3 (75%) 4 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (25%) 4 (100%) 
Omenn syndrome 0 (0%) 1 (100%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 1 (100%) 1 (100%) 
Other immune deficiency - known cause 6 (11%) 13 (24%) 44 (81%) 0 (0%) 0 (0%) 4 (7%) 1 (2%) 1 (2%) 11 (20%) 3 (6%) 46 (85%) 54 
Other T-cell problems 0 (0%) 3 (43%) 4 (57%) 0 (0%) 0 (0%) 0 (0%) 1 (14%) 0 (0%) 1 (14%) 0 (0%) 6 (86%) 
Predisposition to severe viral infections 11 (37%) 21 (70%) 26 (87%) 0 (0%) 2 (7%) 4 (13%) 3 (10%) 3 (10%) 7 (23%) 3 (10%) 26 (87%) 30 
Severe combined immune deficiency (SCID) 9 (14%) 23 (35%) 45 (68%) 0 (0%) 2 (3%) 4 (6%) 3 (5%) 2 (3%) 17 (26%) 8 (12%) 51 (77%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 19 (20%) 29 (30%) 96 (99%) 0 (0%) 1 (1%) 6 (6%) 0 (0%) 2 (2%) 16 (16%) 3 (3%) 96 (99%) 97 
Susceptibility to mycobacteria (MSMD) 3 (38%) 5 (62%) 4 (50%) 0 (0%) 0 (0%) 0 (0%) 1 (12%) 2 (25%) 2 (25%) 1 (12%) 7 (88%) 
TLR pathway abnormality 0 (0%) 1 (50%) 1 (50%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (100%) 2 (100%) 0 (0%) 2 (100%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 3 (21%) 2 (14%) 13 (93%) 0 (0%) 0 (0%) 2 (14%) 0 (0%) 0 (0%) 0 (0%) 2 (14%) 14 (100%) 14 
Wiskott-Aldrich syndrome 0 (0%) 20 (37%) 33 (61%) 0 (0%) 1 (2%) 6 (11%) 3 (6%) 2 (4%) 9 (17%) 5 (9%) 39 (72%) 54 
ImmunodeficiencyUrogenitalSSTISino-pulmonaryCardiacOdontogenicOphthalmicMSKCNSGIBloodstreamAny siteTotal count (N = 3511)
Agammaglobulinemia 18 (7%) 92 (36%) 221 (86%) 0 (0%) 1 (0%) 67 (26%) 25 (10%) 34 (13%) 66 (26%) 29 (11%) 235 (91%) 257 
Ataxia telangiectasia 1 (4%) 3 (12%) 21 (81%) 0 (0%) 0 (0%) 2 (8%) 1 (4%) 1 (4%) 8 (31%) 3 (12%) 24 (92%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 9 (14%) 32 (50%) 33 (52%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 2 (3%) 16 (25%) 9 (14%) 54 (84%) 64 
Autoinflammatory disease 1 (8%) 3 (25%) 5 (42%) 0 (0%) 0 (0%) 2 (17%) 0 (0%) 1 (8%) 1 (8%) 0 (0%) 9 (75%) 12 
CHARGE syndrome 1 (33%) 1 (33%) 2 (67%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (67%) 3 (100%) 
Chronic granulomatous disease 13 (9%) 115 (79%) 123 (85%) 0 (0%) 5 (3%) 8 (6%) 17 (12%) 14 (10%) 75 (52%) 15 (10%) 143 (99%) 145 
Combined immune deficiency 5 (10%) 25 (48%) 40 (77%) 1 (2%) 0 (0%) 11 (21%) 3 (6%) 5 (10%) 12 (23%) 12 (23%) 43 (83%) 52 
Common variable immune deficiency (CVID) 242 (17%) 381 (27%) 1211 (86%) 4 (0%) 18 (1%) 126 (9%) 32 (2%) 62 (4%) 248 (18%) 91 (6%) 1265 (89%) 1416 
Complement deficiency 1 (4%) 9 (35%) 21 (81%) 0 (0%) 0 (0%) 1 (4%) 2 (8%) 7 (27%) 3 (12%) 6 (23%) 23 (88%) 26 
DiGeorge syndrome 22 (4%) 34 (7%) 157 (32%) 7 (1%) 0 (0%) 11 (2%) 2 (0%) 1 (0%) 11 (2%) 19 (4%) 171 (34%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 1 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 2 (8%) 16 (67%) 18 (75%) 0 (0%) 0 (0%) 1 (4%) 1 (4%) 8 (33%) 8 (33%) 5 (21%) 24 (100%) 24 
HLH, including XLP and pigmentary disorders 2 (12%) 5 (31%) 12 (75%) 0 (0%) 0 (0%) 1 (6%) 0 (0%) 1 (6%) 3 (19%) 2 (12%) 13 (81%) 16 
Hyper IgE syndrome 18 (19%) 84 (88%) 88 (92%) 1 (1%) 3 (3%) 4 (4%) 7 (7%) 5 (5%) 19 (20%) 7 (7%) 91 (95%) 96 
Hyper IgM syndrome 3 (6%) 12 (26%) 43 (91%) 0 (0%) 1 (2%) 4 (9%) 0 (0%) 3 (6%) 11 (23%) 5 (11%) 44 (94%) 47 
Hypogammaglobulinemia 34 (16%) 56 (27%) 162 (78%) 0 (0%) 2 (1%) 10 (5%) 3 (1%) 1 (0%) 23 (11%) 6 (3%) 173 (83%) 209 
IgA deficiency 8 (12%) 15 (22%) 63 (93%) 0 (0%) 0 (0%) 4 (6%) 1 (1%) 3 (4%) 16 (24%) 1 (1%) 66 (97%) 68 
IgG subclass deficiency 7 (27%) 6 (23%) 25 (96%) 0 (0%) 2 (8%) 1 (4%) 1 (4%) 1 (4%) 2 (8%) 0 (0%) 25 (96%) 26 
Immune deficiency with syndromic features (not otherwise listed) 4 (50%) 3 (38%) 6 (75%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (12%) 1 (12%) 8 (100%) 
Immune dysregulation 15 (20%) 40 (53%) 66 (88%) 1 (1%) 5 (7%) 9 (12%) 1 (1%) 5 (7%) 20 (27%) 9 (12%) 69 (92%) 75 
Immunodeficiency unknown cause 2 (11%) 5 (26%) 12 (63%) 2 (11%) 0 (0%) 0 (0%) 1 (5%) 2 (11%) 3 (16%) 1 (5%) 16 (84%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 7 (26%) 14 (52%) 16 (59%) 1 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 3 (11%) 1 (4%) 22 (81%) 27 
Interferonopathy (Aicardi-Goutières and others) 0 (0%) 2 (29%) 3 (43%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (14%) 0 (0%) 1 (14%) 4 (57%) 
Leukocyte adhesion deficiency 3 (33%) 9 (100%) 8 (89%) 1 (11%) 2 (22%) 2 (22%) 1 (11%) 0 (0%) 4 (44%) 1 (11%) 9 (100%) 
Mucocutaneous candidiasis 10 (23%) 37 (86%) 32 (74%) 1 (2%) 0 (0%) 3 (7%) 3 (7%) 3 (7%) 11 (26%) 4 (9%) 42 (98%) 43 
Neutropenia 0 (0%) 0 (0%) 2 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (100%) 
NK cell defect 1 (25%) 3 (75%) 4 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (25%) 4 (100%) 
Omenn syndrome 0 (0%) 1 (100%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 1 (100%) 1 (100%) 
Other immune deficiency - known cause 6 (11%) 13 (24%) 44 (81%) 0 (0%) 0 (0%) 4 (7%) 1 (2%) 1 (2%) 11 (20%) 3 (6%) 46 (85%) 54 
Other T-cell problems 0 (0%) 3 (43%) 4 (57%) 0 (0%) 0 (0%) 0 (0%) 1 (14%) 0 (0%) 1 (14%) 0 (0%) 6 (86%) 
Predisposition to severe viral infections 11 (37%) 21 (70%) 26 (87%) 0 (0%) 2 (7%) 4 (13%) 3 (10%) 3 (10%) 7 (23%) 3 (10%) 26 (87%) 30 
Severe combined immune deficiency (SCID) 9 (14%) 23 (35%) 45 (68%) 0 (0%) 2 (3%) 4 (6%) 3 (5%) 2 (3%) 17 (26%) 8 (12%) 51 (77%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 19 (20%) 29 (30%) 96 (99%) 0 (0%) 1 (1%) 6 (6%) 0 (0%) 2 (2%) 16 (16%) 3 (3%) 96 (99%) 97 
Susceptibility to mycobacteria (MSMD) 3 (38%) 5 (62%) 4 (50%) 0 (0%) 0 (0%) 0 (0%) 1 (12%) 2 (25%) 2 (25%) 1 (12%) 7 (88%) 
TLR pathway abnormality 0 (0%) 1 (50%) 1 (50%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (100%) 2 (100%) 0 (0%) 2 (100%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 3 (21%) 2 (14%) 13 (93%) 0 (0%) 0 (0%) 2 (14%) 0 (0%) 0 (0%) 0 (0%) 2 (14%) 14 (100%) 14 
Wiskott-Aldrich syndrome 0 (0%) 20 (37%) 33 (61%) 0 (0%) 1 (2%) 6 (11%) 3 (6%) 2 (4%) 9 (17%) 5 (9%) 39 (72%) 54 
Table 3.

Infection types in IEI

ImmunodeficiencyBacterialViralFungalParasiticAny InfectionTotal count (N = 3511)
Agammaglobulinemia 129 (50%) 81 (32%) 23 (9%) 12 (5%) 235 (91%) 257 
Ataxia telangiectasia 8 (31%) 7 (27%) 3 (12%) 0 (0%) 24 (92%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 17 (27%) 22 (34%) 39 (61%) 3 (5%) 54 (84%) 64 
Autoinflammatory disease 1 (8%) 2 (17%) 0 (0%) 0 (0%) 9 (75%) 12 
CHARGE syndrome 1 (33%) 1 (33%) 0 (0%) 0 (0%) 3 (100%) 
Chronic granulomatous disease 98 (68%) 33 (23%) 75 (52%) 2 (1%) 143 (99%) 145 
Combined immune deficiency 25 (48%) 28 (54%) 12 (23%) 2 (4%) 43 (83%) 52 
Common variable immune deficiency (CVID) 503 (36%) 332 (23%) 218 (15%) 35 (2%) 1265 (89%) 1416 
Complement deficiency 14 (54%) 5 (19%) 3 (12%) 0 (0%) 23 (88%) 26 
DiGeorge syndrome 51 (10%) 53 (11%) 29 (6%) 0 (0%) 171 (34%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 19 (79%) 10 (42%) 3 (12%) 0 (0%) 24 (100%) 24 
HLH, including XLP and pigmentary disorders 5 (31%) 5 (31%) 2 (12%) 0 (0%) 13 (81%) 16 
Hyper IgE syndrome 72 (75%) 29 (30%) 63 (66%) 4 (4%) 91 (95%) 96 
Hyper IgM syndrome 14 (30%) 16 (34%) 19 (40%) 4 (9%) 44 (94%) 47 
Hypogammaglobulinemia 70 (33%) 51 (24%) 26 (12%) 0 (0%) 173 (83%) 209 
IgA deficiency 24 (35%) 13 (19%) 5 (7%) 0 (0%) 66 (97%) 68 
IgG subclass deficiency 6 (23%) 5 (19%) 7 (27%) 0 (0%) 25 (96%) 26 
Immune deficiency with syndromic features (not otherwise listed) 7 (88%) 4 (50%) 0 (0%) 0 (0%) 8 (100%) 
Immune dysregulation 44 (59%) 39 (52%) 23 (31%) 3 (4%) 69 (92%) 75 
Immunodeficiency unknown cause 11 (58%) 8 (42%) 4 (21%) 0 (0%) 16 (84%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 16 (59%) 10 (37%) 8 (30%) 0 (0%) 22 (81%) 27 
Interferonopathy (Aicardi-Goutières and others) 2 (29%) 3 (43%) 1 (14%) 0 (0%) 4 (57%) 
Leukocyte adhesion deficiency 9 (100%) 6 (67%) 4 (44%) 0 (0%) 9 (100%) 
Mucocutaneous candidiasis 23 (53%) 20 (47%) 38 (88%) 1 (2%) 42 (98%) 43 
Neutropenia 1 (50%) 0 (0%) 0 (0%) 1 (50%) 2 (100%) 
NK cell defect 2 (50%) 3 (75%) 2 (50%) 0 (0%) 4 (100%) 
Omenn syndrome 1 (100%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 
Other immune deficiency - known cause 26 (48%) 23 (43%) 6 (11%) 1 (2%) 46 (85%) 54 
Other T-cell problems 2 (29%) 3 (43%) 2 (29%) 0 (0%) 6 (86%) 
Predisposition to severe viral infections 17 (57%) 21 (70%) 13 (43%) 3 (10%) 26 (87%) 30 
Severe combined immune deficiency (SCID) 26 (39%) 29 (44%) 23 (35%) 1 (2%) 51 (77%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 49 (51%) 27 (28%) 18 (19%) 1 (1%) 96 (99%) 97 
Susceptibility to mycobacteria (MSMD) 7 (88%) 2 (25%) 3 (38%) 1 (12%) 7 (88%) 
TLR pathway abnormality 1 (50%) 1 (50%) 1 (50%) 0 (0%) 2 (100%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 6 (43%) 3 (21%) 1 (7%) 0 (0%) 14 (100%) 14 
Wiskott-Aldrich syndrome 18 (33%) 15 (28%) 6 (11%) 0 (0%) 39 (72%) 54 
ImmunodeficiencyBacterialViralFungalParasiticAny InfectionTotal count (N = 3511)
Agammaglobulinemia 129 (50%) 81 (32%) 23 (9%) 12 (5%) 235 (91%) 257 
Ataxia telangiectasia 8 (31%) 7 (27%) 3 (12%) 0 (0%) 24 (92%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 17 (27%) 22 (34%) 39 (61%) 3 (5%) 54 (84%) 64 
Autoinflammatory disease 1 (8%) 2 (17%) 0 (0%) 0 (0%) 9 (75%) 12 
CHARGE syndrome 1 (33%) 1 (33%) 0 (0%) 0 (0%) 3 (100%) 
Chronic granulomatous disease 98 (68%) 33 (23%) 75 (52%) 2 (1%) 143 (99%) 145 
Combined immune deficiency 25 (48%) 28 (54%) 12 (23%) 2 (4%) 43 (83%) 52 
Common variable immune deficiency (CVID) 503 (36%) 332 (23%) 218 (15%) 35 (2%) 1265 (89%) 1416 
Complement deficiency 14 (54%) 5 (19%) 3 (12%) 0 (0%) 23 (88%) 26 
DiGeorge syndrome 51 (10%) 53 (11%) 29 (6%) 0 (0%) 171 (34%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (100%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 19 (79%) 10 (42%) 3 (12%) 0 (0%) 24 (100%) 24 
HLH, including XLP and pigmentary disorders 5 (31%) 5 (31%) 2 (12%) 0 (0%) 13 (81%) 16 
Hyper IgE syndrome 72 (75%) 29 (30%) 63 (66%) 4 (4%) 91 (95%) 96 
Hyper IgM syndrome 14 (30%) 16 (34%) 19 (40%) 4 (9%) 44 (94%) 47 
Hypogammaglobulinemia 70 (33%) 51 (24%) 26 (12%) 0 (0%) 173 (83%) 209 
IgA deficiency 24 (35%) 13 (19%) 5 (7%) 0 (0%) 66 (97%) 68 
IgG subclass deficiency 6 (23%) 5 (19%) 7 (27%) 0 (0%) 25 (96%) 26 
Immune deficiency with syndromic features (not otherwise listed) 7 (88%) 4 (50%) 0 (0%) 0 (0%) 8 (100%) 
Immune dysregulation 44 (59%) 39 (52%) 23 (31%) 3 (4%) 69 (92%) 75 
Immunodeficiency unknown cause 11 (58%) 8 (42%) 4 (21%) 0 (0%) 16 (84%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 16 (59%) 10 (37%) 8 (30%) 0 (0%) 22 (81%) 27 
Interferonopathy (Aicardi-Goutières and others) 2 (29%) 3 (43%) 1 (14%) 0 (0%) 4 (57%) 
Leukocyte adhesion deficiency 9 (100%) 6 (67%) 4 (44%) 0 (0%) 9 (100%) 
Mucocutaneous candidiasis 23 (53%) 20 (47%) 38 (88%) 1 (2%) 42 (98%) 43 
Neutropenia 1 (50%) 0 (0%) 0 (0%) 1 (50%) 2 (100%) 
NK cell defect 2 (50%) 3 (75%) 2 (50%) 0 (0%) 4 (100%) 
Omenn syndrome 1 (100%) 1 (100%) 0 (0%) 0 (0%) 1 (100%) 
Other immune deficiency - known cause 26 (48%) 23 (43%) 6 (11%) 1 (2%) 46 (85%) 54 
Other T-cell problems 2 (29%) 3 (43%) 2 (29%) 0 (0%) 6 (86%) 
Predisposition to severe viral infections 17 (57%) 21 (70%) 13 (43%) 3 (10%) 26 (87%) 30 
Severe combined immune deficiency (SCID) 26 (39%) 29 (44%) 23 (35%) 1 (2%) 51 (77%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 49 (51%) 27 (28%) 18 (19%) 1 (1%) 96 (99%) 97 
Susceptibility to mycobacteria (MSMD) 7 (88%) 2 (25%) 3 (38%) 1 (12%) 7 (88%) 
TLR pathway abnormality 1 (50%) 1 (50%) 1 (50%) 0 (0%) 2 (100%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 6 (43%) 3 (21%) 1 (7%) 0 (0%) 14 (100%) 14 
Wiskott-Aldrich syndrome 18 (33%) 15 (28%) 6 (11%) 0 (0%) 39 (72%) 54 
Table 4.

Malignancy in IEI

ImmunodeficiencyHematologicSolid / LymphomaAny MalignancyTotal count (N = 3511)
Agammaglobulinemia 2 (1%) 0 (0%) 2 (1%) 257 
Ataxia telangiectasia 4 (15%) 2 (8%) 5 (19%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 3 (5%) 1 (2%) 4 (6%) 64 
Autoinflammatory disease 1 (8%) 0 (0%) 1 (8%) 12 
CHARGE syndrome 0 (0%) 0 (0%) 0 (0%) 
Chronic granulomatous disease 3 (2%) 0 (0%) 3 (2%) 145 
Combined immune deficiency 4 (8%) 0 (0%) 4 (8%) 52 
Common variable immune deficiency (CVID) 126 (9%) 14 (1%) 135 (10%) 1416 
Complement deficiency 0 (0%) 0 (0%) 0 (0%) 26 
DiGeorge syndrome 1 (0%) 0 (0%) 1 (0%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 0 (0%) 0 (0%) 0 (0%) 24 
HLH, including XLP and pigmentary disorders 0 (0%) 0 (0%) 0 (0%) 16 
Hyper IgE syndrome 7 (7%) 1 (1%) 8 (8%) 96 
Hyper IgM syndrome 3 (6%) 0 (0%) 3 (6%) 47 
Hypogammaglobulinemia 14 (7%) 2 (1%) 16 (8%) 209 
IgA deficiency 2 (3%) 1 (1%) 2 (3%) 68 
IgG subclass deficiency 2 (8%) 0 (0%) 2 (8%) 26 
Immune deficiency with syndromic features (not otherwise listed) 0 (0%) 0 (0%) 0 (0%) 
Immune dysregulation 6 (8%) 1 (1%) 6 (8%) 75 
Immunodeficiency unknown cause 3 (16%) 1 (5%) 3 (16%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 9 (33%) 9 (33%) 15 (56%) 27 
Interferonopathy (Aicardi-Goutières and others) 1 (14%) 0 (0%) 1 (14%) 
Leukocyte adhesion deficiency 0 (0%) 0 (0%) 0 (0%) 
Mucocutaneous candidiasis 3 (7%) 0 (0%) 3 (7%) 43 
Neutropenia 0 (0%) 1 (50%) 1 (50%) 
NK cell defect 1 (25%) 0 (0%) 1 (25%) 
Omenn syndrome 0 (0%) 0 (0%) 0 (0%) 
Other immune deficiency - known cause 3 (6%) 0 (0%) 3 (6%) 54 
Other T-cell problems 0 (0%) 0 (0%) 0 (0%) 
Predisposition to severe viral infections 4 (13%) 0 (0%) 4 (13%) 30 
Severe combined immune deficiency (SCID) 11 (17%) 0 (0%) 11 (17%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 9 (9%) 0 (0%) 9 (9%) 97 
Susceptibility to mycobacteria (MSMD) 0 (0%) 0 (0%) 0 (0%) 
TLR pathway abnormality 0 (0%) 0 (0%) 0 (0%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 0 (0%) 0 (0%) 0 (0%) 14 
Wiskott-Aldrich syndrome 4 (7%) 2 (4%) 6 (11%) 54 
ImmunodeficiencyHematologicSolid / LymphomaAny MalignancyTotal count (N = 3511)
Agammaglobulinemia 2 (1%) 0 (0%) 2 (1%) 257 
Ataxia telangiectasia 4 (15%) 2 (8%) 5 (19%) 26 
Autoimmune lymphoproliferative syndrome (ALPS) 3 (5%) 1 (2%) 4 (6%) 64 
Autoinflammatory disease 1 (8%) 0 (0%) 1 (8%) 12 
CHARGE syndrome 0 (0%) 0 (0%) 0 (0%) 
Chronic granulomatous disease 3 (2%) 0 (0%) 3 (2%) 145 
Combined immune deficiency 4 (8%) 0 (0%) 4 (8%) 52 
Common variable immune deficiency (CVID) 126 (9%) 14 (1%) 135 (10%) 1416 
Complement deficiency 0 (0%) 0 (0%) 0 (0%) 26 
DiGeorge syndrome 1 (0%) 0 (0%) 1 (0%) 496 
Dyskeratosis congenita 0 (0%) 0 (0%) 0 (0%) 
Ectodermal dysplasia with immunodeficiency (nemo and others) 0 (0%) 0 (0%) 0 (0%) 24 
HLH, including XLP and pigmentary disorders 0 (0%) 0 (0%) 0 (0%) 16 
Hyper IgE syndrome 7 (7%) 1 (1%) 8 (8%) 96 
Hyper IgM syndrome 3 (6%) 0 (0%) 3 (6%) 47 
Hypogammaglobulinemia 14 (7%) 2 (1%) 16 (8%) 209 
IgA deficiency 2 (3%) 1 (1%) 2 (3%) 68 
IgG subclass deficiency 2 (8%) 0 (0%) 2 (8%) 26 
Immune deficiency with syndromic features (not otherwise listed) 0 (0%) 0 (0%) 0 (0%) 
Immune dysregulation 6 (8%) 1 (1%) 6 (8%) 75 
Immunodeficiency unknown cause 3 (16%) 1 (5%) 3 (16%) 19 
Immunodeficiency with myelodysplasia (GATA2 and others) 9 (33%) 9 (33%) 15 (56%) 27 
Interferonopathy (Aicardi-Goutières and others) 1 (14%) 0 (0%) 1 (14%) 
Leukocyte adhesion deficiency 0 (0%) 0 (0%) 0 (0%) 
Mucocutaneous candidiasis 3 (7%) 0 (0%) 3 (7%) 43 
Neutropenia 0 (0%) 1 (50%) 1 (50%) 
NK cell defect 1 (25%) 0 (0%) 1 (25%) 
Omenn syndrome 0 (0%) 0 (0%) 0 (0%) 
Other immune deficiency - known cause 3 (6%) 0 (0%) 3 (6%) 54 
Other T-cell problems 0 (0%) 0 (0%) 0 (0%) 
Predisposition to severe viral infections 4 (13%) 0 (0%) 4 (13%) 30 
Severe combined immune deficiency (SCID) 11 (17%) 0 (0%) 11 (17%) 66 
Specific antibody deficiency with normal Ig concentrations and normal numbers of B cells 9 (9%) 0 (0%) 9 (9%) 97 
Susceptibility to mycobacteria (MSMD) 0 (0%) 0 (0%) 0 (0%) 
TLR pathway abnormality 0 (0%) 0 (0%) 0 (0%) 
Transient hypogammaglobulinemia of infancy with normal numbers of b cells 0 (0%) 0 (0%) 0 (0%) 14 
Wiskott-Aldrich syndrome 4 (7%) 2 (4%) 6 (11%) 54 

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