CTLA4 and immunodeficiency disease: However, the spectrum of malignancies in patients with PIDs as well as in CTLA-4 insufficiency appears to be restricted and derived from the same molecular defect as the immunodeficiency itself; either in the same cell type that has been primarily affected by the immunodeficiency or in another cell type in which malignant transformation could occur secondarily and indirectly facilitated by the underlying PID (32).