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01-01-2018 | Original Article

Chronic Diarrhea in Common Variable Immunodeficiency: a Case Series and Review of the Literature

Authors: Antonio Pecoraro, Liliana Nappi, Ludovica Crescenzi, Francesco P. D’Armiento, Arturo Genovese, Giuseppe Spadaro

Published in: Journal of Clinical Immunology | Issue 1/2018

Abstract

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by reduced immunoglobulin serum levels and absent or impaired antibody production. Clinical manifestations, including infections, inflammatory and autoimmune diseases, and malignancies, also involve various segments of the gastrointestinal tract. Chronic diarrhea is one of the most common gastrointestinal symptoms and may cause a wide spectrum of potentially life-threatening conditions as malabsorption and protein-energy malnutrition. We describe three female CVID adult patients presenting with chronic diarrhea, weight loss, and protein-energy malnutrition due to different underlying conditions. Our review of the literature explores the various gastrointestinal involvements in CVID and points out several histopathological findings proper of the disease, thus highlighting the relevance of the endoscopic and histological assessment in CVID patients presenting with chronic diarrhea.

Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham-Rundles C, de la Morena MT, et al. International consensus document (ICON): common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. 2016;4(1):38–59. https://doi.org/10.1016/j.jaip.2015.07.025.CrossRefPubMed

Boyle JM, Buckley RH. Population prevalence of diagnosed primary immunodeficiency diseases in the United States. J ClinImmunol. 2007;27(5):497–502.

Cunningham-Rundles C. The many faces of common variable immunodeficiency. Hematology. 2012;2012:301–5. https://doi.org/10.1182/asheducation-2012.1.301.PubMedPubMedCentral

Ochtrop ML, Goldacker S, May AM, Rizzi M, Draeger R, Hauschke D, et al. T and B lymphocyte abnormalities in bone marrow biopsies of common variable immunodeficiency. Blood. 2011;118(2):309–18. https://doi.org/10.1182/blood-2010-11-321695.CrossRefPubMed

Taubenheim N, von Hornung M, Durandy A, Warnatz K, Corcoran L, Peter HH, et al. Defined blocks in terminal plasma cell differentiation of common variable immunodeficiency patients. J Immunol. 2005;175(8):5498–503. https://doi.org/10.4049/jimmunol.175.8.5498.CrossRefPubMed

Wehr C, Kivioja T, Schmitt C, Ferry B, Witte T, Eren E, Vlkova M, Hernandez M,Detkova D, Bos PR, Poerksen G, von Bernuth H, Baumann U, Goldacker S, Gutenberger S, Schlesier M, Bergeron-van der Cruyssen F, Le Garff M, Debré P, Jacobs R, JonesJ, Bateman E, Litzman J, van Hagen PM, Plebani A, Schmidt RE, Thon V, Quinti I, Espanol T, Webster AD, Chapel H, Vihinen M, Oksenhendler E, Peter HH, Warnatz K. The EUROclass trial: defining subgroups in common variable immunodeficiency. Blood 2008;111(1):77–85, 1, https://doi.org/10.1182/blood-2007-06-091744.

Warnatz K, Denz A, Dräger R, Braun M, Groth C, Wolff-Vorbeck G, et al. Severe deficiency of switched memory B cells (CD27(+)IgM(−)IgD(−)) in subgroups of patients with common variable immunodeficiency: a new approach to classify a heterogeneous disease. Blood. 2002;99(5):1544–51. https://doi.org/10.1182/blood.V99.5.1544.CrossRefPubMed

Giovannetti A, Pierdominici M, Aiuti F. T-cell homeostasis: the dark(ened) side of common variable immunodeficiency. Blood 2008;112(2):446; author reply 446-7, 446; author reply 447, https://doi.org/10.1182/blood-2008-03-145045.

Ebbo M, Gérard L, Carpentier S, Vély F, Cypowyj S, Farnarier C, et al. Low circulating natural killer cell counts are associated with severe disease in patients with common variable immunodeficiency. EBioMedicine. 2016;6:222–30. https://doi.org/10.1016/j.ebiom.2016.02.025.CrossRefPubMedPubMedCentral

10.

Barbosa RR, Silva SP, Silva SL, Tendeiro R, Melo AC, Pedro E, et al. Monocyte activation is a feature of common variable immunodeficiency irrespective of plasma lipopolysaccharide levels. Clin Exp Immunol. 2012;169(3):263–72. https://doi.org/10.1111/j.1365-2249.2012.04620.x.CrossRefPubMedPubMedCentral

11.

Orange JS, Glessner JT, Resnick E, Sullivan KE, Lucas M, Ferry B, et al. Genome-wide association identifies diverse causes of common variable immunodeficiency. J Allergy Clin Immunol. 2011;127(6):1360–7. https://doi.org/10.1016/j.jaci.2011.02.039.CrossRefPubMedPubMedCentral

12.

Keller MD, Jyonouchi S. Chipping away at a mountain: genomic studies in common variable immunodeficiency. Autoimmun Rev. 2013;12(6):687–9. https://doi.org/10.1016/j.autrev.2012.10.017.CrossRefPubMed

13.

Bogaert DJ, Dullaers M, Lambrecht BN, Vermaelen KY, De Baere E, Haerynck F. Genes associated with common variable immunodeficiency: one diagnosis to rule them all? J Med Genet. 2016;53(9):575–90. https://doi.org/10.1136/jmedgenet-2015-103690.CrossRefPubMed

14.

Al-Herz W, Bousfiha A, Casanova JL, Chatila T, Conley ME, Cunningham-Rundles C, et al. Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency. Front Immunol. 2014;5:162. https://doi.org/10.3389/fimmu.2014.00162.PubMedPubMedCentral

15.

Chapel H, Lucas M, Lee M, Bjorkander J, Webster D, Grimbacher B, et al. Common variable immunodeficiency disorders: division into distinct clinical phenotypes. Blood. 2008;112(2):277–86. https://doi.org/10.1182/blood-2007-11-124545.CrossRefPubMed

16.

Gathmann B, Mahlaoui N, CEREDIH., Gérard L, Oksenhendler E, Warnatz K, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol. 2014;134(1):116–26. https://doi.org/10.1016/j.jaci.2013.12.1077.CrossRefPubMed

17.

Jolles S. The variable in common variable immunodeficiency: a disease of complex phenotypes. J Allergy Clin Immunol Pract. 2013;1(6):545–56. https://doi.org/10.1016/j.jaip.2013.09.015.CrossRefPubMed

18.

Quinti I, Agostini C, Tabolli S, Brunetti G, Cinetto F, Pecoraro A, et al. Malignancies are the major cause of death in patients with adult onset common variable immunodeficiency. Blood. 2012;120(9):1953–4. https://doi.org/10.1182/blood-2012-05-431064.CrossRefPubMed

19.

Resnick ES, Moshier EL, Godbold JH, Cunningham-Rundles C. Morbidity and mortality in common variable immune deficiency over 4 decades. Blood. 2012;119(7):1650–7. https://doi.org/10.1182/blood-2011-09-377945.CrossRefPubMedPubMedCentral

20.

Chapel H, Lucas M, Patel S, Lee M, Cunningham-Rundles C, Resnick E, et al. Confirmation and improvement of criteria for clinical phenotypingin common variable immunodeficiency disorders in replicate cohorts. J AllergyClinImmunol. 2012;130(5):1197–8.

21.

Malphettes M, Gérard L, Carmagnat M, Mouillot G, Vince N, Boutboul D, et al. Late-onset combined immune deficiency: a subset of common variable immunodeficiency with severe T cell defect. Clin Infect Dis. 2009;49(9):1329–38. https://doi.org/10.1086/606059.CrossRefPubMed

22.

Boileau J, Mouillot G, Gérard L, Carmagnat M, Rabian C, Oksenhendler E, et al. Autoimmunity in common variable immunodeficiency: correlation with lymphocyte phenotype in the French DEFI study. J Autoimmun. 2011;36(1):25–32. https://doi.org/10.1016/j.jaut.2010.10.002.CrossRefPubMed

23.

Kalha I, Sellin JH. Common variable immunodeficiency and the gastrointestinal tract. Curr Gastroenterol Rep. 2004;6(5):377–83. https://doi.org/10.1007/s11894-004-0053-y.CrossRefPubMed

24.

Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92(1):34–48. https://doi.org/10.1006/clim.1999.4725.CrossRefPubMed

25.

Agarwal S, Mayer L. Pathogenesis and treatment of gastrointestinal disease in antibody deficiency syndromes. J Allergy Clin Immunol. 2009;124(4):658–64. https://doi.org/10.1016/j.jaci.2009.06.018.CrossRefPubMed

26.

Oksenhendler E, Gérard L, Fieschi C, Malphettes M, Mouillot G, Jaussaud R, et al. Infections in 252 patients with common variable immunodeficiency. Clin Infect Dis. 2008 May 15;46(10):1547–54. https://doi.org/10.1086/587669.CrossRefPubMed

27.

Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C, et al. Italian primary immunodeficiency network.. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. J Clin Immunol. 2007;27(3):308–16. https://doi.org/10.1007/s10875-007-9075-1.CrossRefPubMed

28.

Moss SF, Malfertheiner P. Helicobacter and gastric malignancies. Helicobacter. 2007 Oct;12(Suppl 1):23–30. https://doi.org/10.1111/j.1523-5378.2007.00539.x.CrossRefPubMed

29.

Woodward JM, Gkrania-Klotsas E, Cordero-Ng AY, Aravinthan A, Bandoh BN, Liu H, et al. The role of chronic norovirus infection in the enteropathy associated with common variable immunodeficiency. Am J Gastroenterol. 2015;110(2):320–7. https://doi.org/10.1038/ajg.2014.432.CrossRefPubMed

30.

Woodward J, Gkrania-Klotsas E, Kumararatne D. Chronic norovirus infection and common variable immunodeficiency. Clin Exp Immunol. 2016;188(3):363–70. https://doi.org/10.1111/cei.12884.CrossRefPubMed

31.

Daniels JA, Lederman HM, Maitra A, Montgomery EA. Gastrointestinal tract pathology in patients with common variable immunodeficiency (CVID): a clinicopathologic study and review. Am J Surg Pathol. 2007;31(12):1800–12. https://doi.org/10.1097/PAS.0b013e3180cab60c.CrossRefPubMed

32.

Malamut G, Verkarre V, Suarez F, Viallard JF, Lascaux AS, Cosnes J, et al. The enteropathy associated with common variable immunodeficiency: the delineated frontiers with celiac disease. Am J Gastroenterol. 2010;105(10):2262–75. https://doi.org/10.1038/ajg.2010.214.CrossRefPubMed

33.

Jørgensen SF, Reims HM, Frydenlund D, Holm K, Paulsen V, Michelsen AE, et al. Cross-sectional study of the prevalence of gastrointestinal symptoms and pathology in patients with common variable immunodeficiency. Am J Gastroenterol. 2016;111(10):1467–75. https://doi.org/10.1038/ajg.2016.329.CrossRefPubMed

34.

Hermans PE, Diaz-Buxo JA, Stobo JD. Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med. 1976 Aug;61(2):221–37. https://doi.org/10.1016/0002-9343(76)90173-X.CrossRefPubMed

35.

Hermaszewski RA, Webster AD. Primary hypogammaglobulinaemia: a survey of clinical manifestations and complications. Q J Med. 1993;86(1):31–42.PubMed

36.

Washington K, Stenzel TT, Buckley RH, Gottfried MR. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. 1996;20(10):1240–52. https://doi.org/10.1097/00000478-199610000-00010.CrossRefPubMed

37.

Aslam A, Misbah SA, Talbot K, Chapel H, Vitamin E. Deficiency induced neurological disease in common variable immunodeficiency: two cases and a review of the literature of vitamin E deficiency. Clin Immunol. 2004;112(1):24–9. https://doi.org/10.1016/j.clim.2004.02.001.CrossRefPubMed

38.

Aukrust P, Müller F, Ueland T, Svardal AM, Berge RK, Frøland SS. Decreased vitamin A levels in common variable immunodeficiency: vitamin A supplementation in vivo enhances immunoglobulin production and downregulates inflammatory responses. Eur J Clin Investig. 2000;30(3):252–9. https://doi.org/10.1046/j.1365-2362.2000.00619.x.CrossRef

39.

Genovese A, Spadaro G, Santoro L, Gasparo Rippa P, Onorati AM, Marone G. Giardiasis as a cause of hypokalemic myopathy in congenital immunodeficiency. Int J Clin Lab Res. 1996;26(2):132–5. https://doi.org/10.1007/BF02592356.CrossRefPubMed

40.

Sanges M, Spadaro G, Miniero M, Mattera D, Sollazzo R, D'Armiento FP, et al. Efficacy of subcutaneous immunoglobulins in primary immunodeficiency with Crohn's-like phenotype: report of a case. Eur Rev Med Pharmacol Sci. 2015;19(14):2641–5.PubMed

41.

Atarod L, Raissi A, Aghamohammadi A, Farhoudi A, Khodadad A, Moin M, et al. Review of gastrointestinal disorders in patients with primary antibody immunodeficiencies during a 10-year period (1990-2000), in children hospital medical center. Iran J Allergy Asthma Immunol. 2003;2(2):75–9. https://doi.org/02.02/ijaai.7579

42.

Maarschalk-Ellerbroek LJ, Oldenburg B, Mombers IM, Hoepelman AI, Brosens LA, Offerhaus GJ, et al. Outcome of screening endoscopy in common variable immunodeficiency disorder and X-linked agammaglobulinemia. Endoscopy. 2013;45(4):320–3. https://doi.org/10.1055/s-0032-1326078.CrossRefPubMed

43.

Khodadad A, Aghamohammadi A, Parvaneh N, Rezaei N, Mahjoob F, Bashashati M, et al. Gastrointestinal manifestations in patients with common variable immunodeficiency. Dig Dis Sci. 2007;52(11):2977–83. https://doi.org/10.1007/s10620-006-9736-6.CrossRefPubMed

44.

Wood P, Stanworth S, Burton J, Jones A, Peckham DG, Green T, et al. Network.. Recognition, clinical diagnosis and management of patients with primary antibody deficiencies: a systematic review. Clin Exp Immunol. 2007;149(3):410–23. https://doi.org/10.1111/j.1365-2249.2007.03432.x.CrossRefPubMedPubMedCentral

45.

Agarwal S, Mayer L. Diagnosis and treatment of gastrointestinal disorders in patients with primary immunodeficiency. Clin Gastroenterol Hepatol. 2013;11(9):1050–63. https://doi.org/10.1016/j.cgh.2013.02.024.CrossRefPubMedPubMedCentral

46.

Castellano G, Moreno D, Galvao O, Ballestín C, Colina F, Mollejo M, et al. Malignant lymphoma of jejunum with common variable hypogammaglobulinemia and diffuse nodular hyperplasia of the small intestine. A case study and literature review. J Clin Gastroenterol. 1992;15(2):128–35. https://doi.org/10.1097/00004836-199209000-00010.CrossRefPubMed

47.

Byrne MF, Royston D, Patchett SE. Association of common variable immunodeficiency with atypical collagenous colitis. Eur J Gastroenterol Hepatol. 2003;15(9):1051–3. https://doi.org/10.1097/00042737-200309000-00019.CrossRefPubMed

48.

Mannon PJ, Fuss IJ, Dill S, Friend J, Groden C, Hornung R, et al. Excess IL-12 but not IL-23 accompanies the inflammatory bowel disease associated with common variable immunodeficiency. Gastroenterology. 2006;131(3):748–56. https://doi.org/10.1053/j.gastro.2006.06.022.CrossRefPubMed

49.

Baumgart DC, Sandborn WJ. Crohn's disease. Lancet. 2012;380(9853):1590–605. https://doi.org/10.1016/S0140-6736(12)60026-9.CrossRefPubMed

50.

Peters CP, Mjösberg JM, Bernink JH, Spits H. Innate lymphoid cells in inflammatory bowel diseases. Immunol Lett. 2016;172:124–31. https://doi.org/10.1016/j.imlet.2015.10.004.CrossRefPubMed

51.

Cols M, Rahman A, Maglione PJ, Garcia-Carmona Y, Simchoni N, Ko HB, et al. Cunningham-rundles C. expansion of inflammatory innate lymphoid cells in patients with common variable immune deficiency. J Allergy Clin Immunol, 137. 2016;(4):1206–15.e1-6.

52.

Elnachef N, McMorris M, Chey WD. Successful treatment of common variable immunodeficiency disorder-associated diarrhea with budesonide: a case report. Am J Gastroenterol. 2007;102(6):1322–5. https://doi.org/10.1111/j.1572-0241.2007.01141.x.CrossRefPubMed

53.

Chua I, Standish R, Lear S, Harbord M, Eren E, Raeiszadeh M, et al. Anti-tumour necrosis factor-alpha therapy for severe enteropathy in patients with common variable immunodeficiency (CVID). Clin Exp Immunol. 2007;150(2):306–11. https://doi.org/10.1111/j.1365-2249.2007.03481.x.CrossRefPubMedPubMedCentral

54.

Nos P, Bastida G, Beltran B, Aguas M, Ponce J. Crohn's disease in common variable immunodeficiency: treatment with antitumor necrosis factor alpha. Am J Gastroenterol. 2006;101(9):2165–6. https://doi.org/10.1111/j.1572-0241.2006.00763_5.x.CrossRefPubMed

55.

Akazawa Y, Takeshima F, Yajima H, Imanishi D, Kanda T, Matsushima K, et al. Infliximab therapy for Crohn's-like disease in common variable immunodeficiency complicated by massive intestinal hemorrhage: a case report. BMC Res Notes. 2014;7(1):382. https://doi.org/10.1186/1756-0500-7-382.CrossRefPubMedPubMedCentral

56.

Saldaña Dueñas C, Rubio Iturria S. Immmunodeficiencies and autoimmune diseases: common variable immunodeficiency and Crohn-like. Rev Esp Enferm Dig. 2016 Aug;108(8):520–3. https://doi.org/10.17235/reed.2015.3872/2015.PubMed

57.

Vázquez-Morón JM, Pallarés-Manrique H, Martín-Suárez IJ, Benítez-Rodríguez B, Ramos-Lora M. Crohn's-like disease in a patient with common variable immunodeficiency treated with azathioprine and adalimumab. Rev Esp Enferm Dig. 2013;105(5):299–302. https://doi.org/10.4321/S1130-01082013000500010.CrossRefPubMed

58.

Uzzan M, Ko HM, Mehandru S, Cunningham-Rundles C. Gastrointestinal disorders associated with common variable immune deficiency (CVID) and chronic granulomatous disease (CGD). Curr Gastroenterol Rep. 2016;18(4):17. https://doi.org/10.1007/s11894-016-0491-3.CrossRefPubMedPubMedCentral

59.

Teahon K, Webster AD, Price AB, Weston J, Bjarnason I. Studies on the enteropathy associated with primary hypogammaglobulinaemia. Gut. 1994;35(9):1244–9. https://doi.org/10.1136/gut.35.9.1244.CrossRefPubMedPubMedCentral

60.

Chahal P, Weiler CR, Murray JA. Common variable immune deficiency and gastrointestinal tract. Gastroenterology 2005; 128 (Suppl): A-502: T1552.

61.

Luzi G, Zullo A, Iebba F, Rinaldi V, Sanchez Mete L, Muscaritoli M, et al. Duodenal pathology and clinical-immunological implications in common variable immunodeficiency patients. Am J Gastroenterol. 2003;98(1):118–21. https://doi.org/10.1111/j.1572-0241.2003.07159.x.CrossRefPubMed

62.

Brar P, Kwon GY, Egbuna II, Holleran S, Ramakrishnan R, Bhagat G, et al. Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Dig Liver Dis. 2007;39(1):26–9. https://doi.org/10.1016/j.dld.2006.07.014.CrossRefPubMed

63.

Sharma V, Ahuja A. Images in clinical medicine. Nodular lymphoid hyperplasia. N Engl J Med. 2016;375(3):e3. https://doi.org/10.1056/NEJMicm1514403.CrossRefPubMed

64.

Choi JH, Han DS, Kim J, Yi K, YH O, Kim Y. Diffuse nodular lymphoid hyperplasia of the intestine caused by common variable immunodeficiency and refractory giardiasis. Intern Med. 2017;56(3):283–7. https://doi.org/10.2169/internalmedicine.56.7305.CrossRefPubMedPubMedCentral

65.

Zullo A, Romiti A, Rinaldi V, Vecchione A, Tomao S, Aiuti F, et al. Gastric pathology in patients with common variable immunodeficiency. Gut. 1999;45(1):77–81. https://doi.org/10.1136/gut.45.1.77.CrossRefPubMedPubMedCentral

66.

Desar IM, van Deuren M, Sprong T, Jansen JB, Namavar F, Vandenbroucke-Grauls CM, et al. Serum bactericidal activity against helicobacter pylori in patients with hypogammaglobulinaemia. Clin Exp Immunol. 2009;156(3):434–9. https://doi.org/10.1111/j.1365-2249.2009.03909.x.CrossRefPubMedPubMedCentral

67.

Dhalla F, da Silva SP, Lucas M, Travis S, Chapel H. Review of gastric cancer risk factors in patients with common variable immunodeficiency disorders, resulting in a proposal for a surveillance programme. Clin Exp Immunol. 2011;165(1):1–7. https://doi.org/10.1111/j.1365-2249.2011.04384.x.CrossRefPubMedPubMedCentral

68.

Leung DY, Kelly CP, Boguniewicz M, Pothoulakis C, LaMont JT, Flores A. Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr. 1991;118(4 Pt 1):633–7. https://doi.org/10.1016/S0022-3476(05)83393-1.CrossRefPubMed

69.

Salcedo J, Keates S, Pothoulakis C, Warny M, Castagliuolo I, LaMont JT, et al. Intravenous immunoglobulin therapy for severe Clostridium Difficile colitis. Gut. 1997;41(3):366–70. https://doi.org/10.1136/gut.41.3.366.CrossRefPubMedPubMedCentral

70.

Jolles S, Orange JS, Gardulf A, Stein MR, Shapiro R, Borte M, et al. Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease. Clin Exp Immunol. 2015;179(2):146–60. https://doi.org/10.1111/cei.12485.CrossRefPubMedPubMedCentral

71.

Bonilla FA. Intravenous and subcutaneous immunoglobulin G replacement therapy. Allergy Asthma Proc. 2016;37(6):426–31. https://doi.org/10.2500/aap.2016.37.3987.CrossRefPubMed

72.

Bonilla FA. Pharmacokinetics of immunoglobulin administered via intravenous or subcutaneous routes. Immunol Allergy Clin N Am. 2008;28(4):803–19. https://doi.org/10.1016/j.iac.2008.06.006.CrossRef

73.

Liesch Z, Hanck C, Werth B, Kuhn M, Liesch M, Reinhart WH. Diarrhea and weight loss in common variable immunodeficiency. Z Gastroenterol. 2004;42(07):599–603. https://doi.org/10.1055/s-2004-813184.CrossRefPubMed

74.

Cunningham-Rundles C. How I treat common variable immune deficiency. Blood. 2010;116(1):7–15. https://doi.org/10.1182/blood-2010-01-254417.CrossRefPubMedPubMedCentral

Title: Chronic Diarrhea in Common Variable Immunodeficiency: a Case Series and Review of the Literature
Authors: Antonio Pecoraro
Liliana Nappi
Ludovica Crescenzi
Francesco P. D’Armiento
Arturo Genovese
Giuseppe Spadaro
Publication date: 01-01-2018
Publisher: Springer US
Published in: Journal of Clinical Immunology / Issue 1/2018
Print ISSN: 0271-9142
Electronic ISSN: 1573-2592
DOI: https://doi.org/10.1007/s10875-017-0461-z

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