For instance, in patients with hyper IgM syndrome, a rare primary immunodeficiency disorder, the blood titers of IgM can be abnormally elevated while the concentrations of IgG, IgA, and IgE are decreased.[91] In patients suffering from chronic liver diseases and autoimmune diseases, the IgM is predominantly monomeric instead of multimeric.[92] To make matters worse, IgM levels and functions undergo dynamic changes during disease progression and medication, especially in cancer patients receiving chemotherapy, severely exacerbating the unpredictability of liposome clinical use. The gene discussed is CD40LG; the disease is cancer.