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

Sim, Beatrice; Ng, Jun Yen; Teh, Benjamin W; Talaulikar, Dipti

doi:10.1080/10428194.2022.2131424

Cited by 4 publications

(2 citation statements)

References 58 publications

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“…The persistence in hepatocytes of the full-length, covalently closed circular DNA in a latent state acts as a reservoir for HBV reactivation in those subjects who do not completely clear the virus[ 11 ]. Vaccination protects against HBV infection by stimulating the production of hepatitis B surface antibodies (anti-HBs), and hypogammaglobulinemia is the predominant inherent immune defect in patients with hematologic malignancies[ 12 ]. All drugs, therefore, capable of reducing protective immunoglobulin levels against hepatitis B surface antigen (HBsAg) could theoretically increase the risk of HBVr in these patients.…”

Section: The Immune Responses Against Hbv Infectionmentioning

confidence: 99%

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

Barone

2024

World J Gastroenterol

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In this editorial, we discussed the apparent discrepancy between the findings described by Colapietro et al , in their case report and data found in the literature. Colapietro et al reported a case of hepatitis B virus (HBV)-related hepatic decompensation in a patient with chronic myeloid leukemia and a previously resolved HBV infection who was receiving Bruton’s tyrosine kinase (BTK) inhibitor therapy. First of all, we recapitulated the main aspects of the immune system involved in the response to HBV infection in order to underline the role of the innate and adaptive response, focusing our attention on the protective role of anti-HBs. We then carefully analyzed literature data on the risk of HBV reactivation (HBVr) in patients with previous HBV infection who were treated with either tyrosine kinase inhibitors or BTK inhibitors for their hematologic malignancies. Based on literature data, we suggested that several factors may contribute to the different risks of HBVr: The type of hematologic malignancy; the type of therapy (BTK inhibitors, especially second-generation, seem to be at a higher risk of HBVr than those with tyrosine kinase inhibitors); previous exposure to an anti-CD20 as first-line therapy; and ethnicity and HBV genotype. Therefore, the warning regarding HBVr in the specific setting of patients with hematologic malignancies requires further investigation.

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Section: The Immune Responses Against Hbv Infectionmentioning

confidence: 99%

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

Barone

2024

World J Gastroenterol

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“…Secondary immunodeficiency (SID), mainly in the form of acquired hypogammaglobulinemia in hematological malignancies (HMs), can develop due to either the underlying disease or as a consequence of therapy (1,2). Patients with SID may experience increased susceptibility to infections, ranging from mild to severe, including opportunistic bacterial, viral, and fungal infections (3,4).…”

Section: Introductionmentioning

confidence: 99%

Management of secondary immunodeficiency in hematological malignancies: a Delphi consensus from the Middle East

Dimou,

Abuzakouk,

Al Ahmad

et al. 2024

Front. Hematol.

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Secondary immunodeficiency (SID), acquired hypogammaglobinemia, is an immunodeficiency caused by different factors like diseases, medications, and/or nutrition disorders. Most patients with hematological malignancies (HM), namely chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), experience such SID. These patients have a consistently high risk of infection throughout the disease course. Traditional chemotherapy and novel agents used to treat HM may further increase infection susceptibility. Immunoglobulin replacement therapy (IgRT) is an effective management option for SID. The prevalence of SID in the Middle East needs better documentation. Healthcare providers should consider and evaluate SID in patients at risk, monitor for infection occurrence, and treat accordingly (including initiating IgRT when indicated). A Delphi initiative was conducted by a consensus panel of 15 experts from the Middle East who have over 20 years of experience in actively managing patients with SID. The modified Delphi process was used, and 16 questions reached a consensus on managing SID patients with IgRT. In addition, the consensus panel of Middle East experts recommended real-world practice recommendations regarding initiating, dosing, and discontinuing IgRT in managing SID. This consensus recommendation aims to assist healthcare practitioners in the Middle East in evidence-based clinical decision-making for better management of SID.

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Treatment patterns and burden of infection in patients with chronic lymphocytic leukemia and secondary immunodeficiency: a retrospective database study

Siffel,

Richter,

Anderson-Smits

et al. 2024

Ann Hematol

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Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and secondary immunodeficiency disease (SID) are susceptible to severe, recurrent, or persistent infections. This retrospective cohort study assessed the burden of infection in patients with CLL/SLL with and without SID, and in immunoglobulin replacement therapy (IgRT)-treated and -untreated patients with CLL/SLL and SID. Anonymized data from the US Optum-Humedica database (Oct-1-2015–Mar-10-2020) were used. Eligible patients aged ≥ 18 years with a confirmed CLL/SLL diagnosis were assigned to cohorts (SID or no-SID) using an algorithm based on serum IgG levels < 5.0 g/L, hypogammaglobulinemia diagnosis codes, and ≥ 1 major infection. A further sub-categorization was made based on patients with SID who received IgRT and those who did not. During 12-month follow-up, patients with CLL/SLL and SID were significantly more likely to experience infections (70.1% vs. 30.4%), including severe bacterial infections (39.8% vs. 9.2%), and infections requiring hospitalization (27.7% vs. 5.8%) than patients without SID. The use of anti-infectives and healthcare resource utilization (HCRU) was also higher in the SID cohort versus the no-SID cohort. Overall survival was shorter in patients with SID than those without (12.3 vs. 16.9 months). In patients with CLL/SLL and SID, burden of infection and HCRU were greater in IgRT-treated patients than in no-IgRT patients, potentially highlighting the IgRT-treated cohort as a more vulnerable population. Increasing understanding of SID burden may help to improve outcomes in patients with CLL/SLL. Further research is needed to develop guidance for IgRT use and to assess the benefits of IgRT in this vulnerable population.

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

Cited by 4 publications

References 58 publications

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

Management of secondary immunodeficiency in hematological malignancies: a Delphi consensus from the Middle East

Treatment patterns and burden of infection in patients with chronic lymphocytic leukemia and secondary immunodeficiency: a retrospective database study

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