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Nijmegen Breakage Syndrome: Clinical and Immunological Features, Long-Term Outcome and Treatment Options – a Retrospective Analysis

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Abstract

Purpose

Nijmegen Breakage Syndrome (NBS) is a rare inherited condition, characterized by microcephaly, chromosomal instability, immunodeficiency, and predisposition to malignancy. This retrospective study, characterizing the clinical and immunological status of patients with NBS at time of diagnosis, was designed to assess whether any parameters were useful in disease prognosis, and could help determine patients qualified for hematopoietic stem cell transplantation.

Methods

The clinical and immunological characteristics of 149 NBS patients registered in the online database of the European Society for Immune Deficiencies were analyzed.

Results

Of the 149 NBS patients, 91 (61 %), of median age 14.3 years, remained alive at the time of analysis. These patients were clinically heterogeneous, with variable immune defects, ranging from negligible to severe dysfunction. Humoral deficiencies predisposed NBS patients to recurrent/chronic respiratory tract infections and worsened long-term clinical prognosis. Eighty malignancies, most of lymphoid origin (especially non-Hodgkin’s lymphomas), were diagnosed in 42 % of patients, with malignancy being the leading cause of death in this cohort. Survival probabilities at 5, 10, 20 and 30 years of age were 95, 85, 50 and 35 %, respectively, and were significantly lower in patients with than without malignancies.

Conclusions

The extremely high incidence of malignancies, mostly non-Hodgkin’s lymphomas, was the main risk factor affecting survival probability in NBS patients. Because treatment of NBS is very difficult and frequently unsuccessful, the search for an alternative medical intervention such as hematopoietic stem cell transplantation is of great clinical importance.

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Acknowledgments

This work was supported in part by grant N N407 1714 34 from the Polish Ministry of Science and Higher Education and by internal grant no. S123/2012 funded by the CMHI, Warsaw, Poland.

Conflict of Interests

Urszula Skarżyńska was supported by EURO-GENE-SCAN 223293 grant, Benjamin Gathmann has served as an ESID Online Database Coordinator, which is supported by industry. The remaining authors declare that they have no conflicts of interest.

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Correspondence to Beata Wolska-Kuśnierz.

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Wolska-Kuśnierz, B., Gregorek, H., Chrzanowska, K. et al. Nijmegen Breakage Syndrome: Clinical and Immunological Features, Long-Term Outcome and Treatment Options – a Retrospective Analysis. J Clin Immunol 35, 538–549 (2015). https://doi.org/10.1007/s10875-015-0186-9

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  • DOI: https://doi.org/10.1007/s10875-015-0186-9

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