Immunoglobulin replacement in hematological malignancies: a focus on evidence, alternatives, dosing strategy, and cessation rule

Abstract

Acquired hypogammaglobulinemia or secondary immunodeficiency (SID) occurs commonly in hematological malignancies with increasing incidence and complexity in the era of modern therapies. Despite current practice of immunoglobulin replacement (IgRT) in SID, the evidence is lacking, especially for newer treatments. We discuss the current evidence for IgRT in various disease groups including issues, such as actual or ideal body weight (IBW)-based dosing, length of treatment, antibiotic prophylaxis, and vaccination. Incidence of SID with newer treatment is lacking. While there is a trend toward decreased respiratory infections and hospitalizations with IgRT, this is not consistent across all disease course or treatment groups. Dosing and indications for cessation of IgRT are also inadequately characterized. Further randomized controlled trials (RCTs) and observational studies are required to assess the optimal indications, timing, and duration of IgRT to improve the efficacy, safety, and cost-effectiveness. Assessment of alternative and adjunctive therapies, such as vaccination and antibiotic prophylaxis could also improve the outcomes and costs.

Keywords:

• Acquired hypogammaglobulinemia
• lymphoma
• myeloma
• chemotherapy
• immunoglobulin replacement
• novel therapies

Disclosure statement

BWT has received research funding from MSD, Seqirus, and Sanofi and is on the advisory board for CSL-Behring and Takeda.

DT chairs the Hematology Specialist Working Group (SWG) at the National Blood Authority (NBA), has received research funding from Roche and Janssen, and is on the advisory boards for CSL-Behring and Takeda.

The other authors report no competing interests.