American Journal of Pharmacological Sciences
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American Journal of Pharmacological Sciences. 2020, 8(1), 14-20
DOI: 10.12691/ajps-8-1-4
Open AccessArticle

Retrospective Evaluation of Intravenous Immunoglobulin Use in Adult Hematology Practice

Istemi SERIN1, , Feyza YAYLACI MERT2, Hasan GOZE1 and Osman YOKUS1

1University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey

2University of Health Sciences, Istanbul Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey

Pub. Date: May 18, 2020

Cite this paper:
Istemi SERIN, Feyza YAYLACI MERT, Hasan GOZE and Osman YOKUS. Retrospective Evaluation of Intravenous Immunoglobulin Use in Adult Hematology Practice. American Journal of Pharmacological Sciences. 2020; 8(1):14-20. doi: 10.12691/ajps-8-1-4


Intravenous immunoglobulin (IVIGs) preparations, which are used in the treatment of many immune-based diseases, also have an important place in hematology practice. It is an important treatment option with many different immunoregulatory roles. There is a limitation of its use on adult patients due to the lack of retrospective data. In our study, the retrospective usage indications, responses and rates of IVIG preparations evaluated in our Hematology Clinic and used in various indications between January 2010 and January 2020 were attempted to be put forth. Our targets for treatment responses were as follows: For immune thrombocytopenia, the platelet count target was 30000 x 103/µL and above; no hospitalization need for secondary hypogammaglobulinemia; no replacement need for hemolytic anemia after IVIG and a hemoglobin level above 8 g/dl. When 166 patients were examined in total, 66 were diagnosed with immune thrombocytopenic purpura (ITP) (39.8%) and 19 chronic lymphocytic leukemia (CLL) (11.4%). There were emergency indications for all patients with thrombocytopenia before getting a primary diagnosis. The number of patients who used IVIG before getting a primary diagnosis was 79 (47.6%), 41 of whom (51.9%) were diagnosed with immune thrombocytopenic purpura in follow up. The expected response was 36.1% with 60 patients within the entire patient group. With further examination performed after emergency usage, the diagnoses received by the patients were revealed. The response was 58.5% with 24 patients in whom IVIG was used under emergency conditions and deep thrombocytopenia before getting a primary diagnosis and were diagnosed with ITP after further examinations.

IVIG Immunoregulatory Immunocomplexes Immune Thrombocytopenic Purpura Malignancies Alloimmunisation Off-Label Usage

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[1]  Zülfikar B, Koç B. Use of intravenous immunoglobulin in pediatric practice. Turk Pediatri Ars. 2014; 49(4): 282-288. Published 2014 Dec 1.
[2]  Benbrahim O, Viallard JF, Choquet S, et al. A French observational study describing the use of human polyvalent immunoglobulins in hematological malignancy-associated secondary immunodeficiency. Eur J Haematol. 2018; 101(1): 48-56.
[3]  Evers D, Zwaginga JJ, Tijmensen J, et al. Treatments for hematologic malignancies in contrast to those for solid cancers are associated with reduced red cell alloimmunization. Haematologica. 2017; 102(1): 52-59.
[4]  Singhal D, Kutyna MM, Chhetri R, et al. Red cell alloimmunization is associated with development of autoantibodies and increased red cell transfusion requirements in myelodysplastic syndrome. Haematologica. 2017; 102(12): 2021-2029.
[5]  Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia [published correction appears in Blood Adv. 2020 Jan 28; 4(2): 252]. Blood Adv. 2019; 3(23): 3829-3866.
[6]  Zent CS, Kay NE. Autoimmune complications in chronic lymphocytic leukaemia (CLL). Best Pract Res Clin Haematol. 2010; 23(1): 47-59.
[7]  Stiegler G, Sperr W, Lorber C et al. Red cell antibodies in frequently transfused patients with myelodysplastic syndrome. Ann Hematol. 2001; 80(6): 330-333.
[8]  Sanz C, Nomdedeu M, Belkaid M et al. Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia. Transfusion. 2013; 53(4): 710-715.
[9]  Novaretti MC, Sopelete CR, Velloso ER et al. Immunohematological findings in myelodysplastic syndrome. Acta Haematol. 2001; 105(1): 1-6.
[10]  Hauck-Dlimi B, Achenbach S, Strobel J et al. Prevention and management of transfusion-induced alloimmunization: current perspectives. International Journal of Clinical Transfusion Medicine. 2014; 2: 59-63.
[11]  Na IK, Buckland M, Agostini C et al. Current clinical practice and challenges in the management of secondary immunodeficiency in hematological malignancies. Eur J Haematol. 2019; 102(6): 447-456.
[12]  Dhalla F, Lucas M, Schuh A et al. Antibody deficiency secondary to chronic lymphocytic leukemia: Should patients be treated with prophylactic replacement immunoglobulin. J Clin Immunol. 2014; 34(3): 277-282.
[13]  Forconi F, Moss P. Perturbation of the normal immune system in patients with CLL. Blood. 2015; 126(5): 573-581.
[14]  Wadhwa PD, Morrison VA. Infectious complications of chronic lymphocytic leukemia. Semin Oncol. 2006; 33(2): 240-249.
[15]  Svensson T, Höglund M, Cherif H. Clinical significance of serum immunoglobulin G subclass deficiency in patients with chronic lymphocytic leukemia. Scand J Infect Dis. 2013; 45(7): 537-542.
[16]  Best OG, Crassini K, Freeman JA et al. CLL Australian Research Consortium The clinical significance of hypogammaglobulinaemia and serum immunoglobulin G subclass deficiency in patients with chronic lymphocytic leukaemia (CLL). Scand J Infect Dis. 2013 Sep; 45(9): 729. Epub 2013 Jul 5.
[17]  Andrea V, Nicolo C,Francesco C et al. Clinical profile associated with infections in patients with chronic lymphocytic leukaemia. Protective role of immunglobulin in replacement therapy. Haematologica. 2015 Dec; 100(12): E515-E-518.
[18]  Rozman C, Montserrat E, Viñolas N. Serum immunoglobulins in B-chronic lymphocytic leukemia. Natural history and prognostic significance. Cancer. 1988; 61(2): 279-283.
[19]  Freeman JA, Crassini KR, Best OG et al. Immunoglobulin G subclass deficiency and infection risk in 150 patients with chronic lymphocytic leukemia. Leuk Lymphoma. 2013; 54(1): 99-104.
[20]  Parikh SA, Leis JF, Chaffee KG et al. Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes. Cancer. 2015 Sep 1; 121(17): 2883-91.
[21]  Davey FR, Kurec AS, Tomar RH et al. Serum immunoglobulins and lymphocyte subsets in chronic lymphocytic leukemia. Am J Clin Pathol. 1987; 87(1): 60-65.
[22]  Shvidel L, Tadmor T, Braester A et al. Serum immunoglobulin levels at diagnosis have no prognostic significance in stage chronic lymphocytic leukemia: a study of 1113 cases from the Israeli CLL Study Group. Eur J Haematol. 2014; 93: 29-33.
[23]  Levy R, Mahévas M, Galicier L et al. Profound symptomatic hypogammaglobulinemia: a rare late complication after rituximab treatment for immune thrombocytopenia. Report of 3 cases and systematic review of the literature. Autoimmun Rev. 2014; 13(10): 1055-1063.
[24]  Fernández Romero DS, Torre MG, Larrauri BJ et al. Rituximab e hipogammaglobulinemia [Rituximab and hypogammaglobulinemia]. Medicina (B Aires). 2015; 75(5): 319-323.
[25]  Roberts DM, Jones RB, Smith RM et al. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun. 2015; 57: 60-65.
[26]  Casulo C, Maragulia J, Zelenetz AD. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk. 2013; 13(2): 106-111.
[27]  M. Makatsori, S. Kiani-Alikhan, A.L. Manson et al. Hypogammaglobulinaemia after rituximab treatment—incidence and outcomes. An International Journal of Medicine, Volume 107, Issue 10, October 2014, Pages 821-828.