Intravenous Immunoglobulin Prophylaxis Is Associated with Decreased Rate of Infection-Related Hospitalizations in Multiple Myeloma Patients

Sheu, Michael; Garcia, Sofia Molina; Patel, Meera; Granat, Lauren M.; Dhillon, Puneet; Awada, Hussein; Anwer, Faiz; Khouri, Jack; Williams, Louis; Rudoni, Joslyn; Majeed, Aneela

doi:10.1182/blood-2022-158472

Cited by 4 publications

(2 citation statements)

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“…[27] Interestingly, multiple studies have confirmed that the application of IVIG could reduce the incidence and mortality of infections in individuals with immune abnormalities. [28–31] Therefore, we speculate that our patient might have had different treatment outcomes if immunosuppressive drugs were switched to IVIG as early as possible. IVIG is also a first-line treatment option, and in theory, the use of IVIG is not only beneficial for the control of CIDP, but also reduces the mortality rate of infected patients.…”

Section: Discussionmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy with pulmonary nocardiosis: A case report

Yan,

Liu,

Gao

2024

Medicine

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Rationale: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment method aims to suppress potential immunopathology. Nocardiosis is a rare, destructive, opportunistic disease. We report a case of failed treatment of CIDP combined with pulmonary nocardiosis, and for the first time, we link these 2 diseases together. Patient concerns: A 65-year-old man developed symmetrical limb weakness. Four months later, he was diagnosed with CIDP and started receiving glucocorticoid (GC) treatment. The disease progressed slowly and was treated with mycophenolate mofetil (MMF) in combination. He did not follow the doctor requirements for monthly follow-up visits, and the preventive medication for sulfamethoxazole/trimethoprim was not strictly implemented. Two months after the combination therapy, the patient developed fever, coughing and sputum production, as well as fatigue and poor appetite. Based on imaging and etiological results, he was diagnosed with pulmonary nocardiosis. Diagnoses: Chronic inflammatory demyelinating polyneuropathy, pulmonary nocardiosis. Interventions: After treatment with antibiotics, the patient lung infection temporarily improved. However, the patient CIDP condition progressed, limb weakness worsened, respiratory muscle involvement occurred, and intravenous immunoglobulin (IVIG) was administered. However, there was no significant improvement in the condition, and the patient died. Outcomes: In this report, we present a case of a patient with CIDP and pulmonary nocardiosis. It is worth noting that in order to avoid the progression and recurrence of CIDP, we did not stop using related therapeutic drugs during the treatment process, the patient had repeatedly refused to use IVIG. Despite this, the patient condition worsened when lung inflammation improved, leading to persistent respiratory failure and ultimately death. Treatment contradictions, medication issues, and patient compliance issues reflected in this case are worth considering. Lessons: For patients with CIDP receiving immunosuppressive therapy, attention should be paid to the occurrence and severity of Nocardia infection. Therefore, early detection and treatment are necessary. We need to pay attention to the compliance of patients with prophylactic use of antibiotics, strengthen the follow-up, and urge them to return to their appointments on time.

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Section: Discussionmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy with pulmonary nocardiosis: A case report

Yan,

Liu,

Gao

2024

Medicine

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“…Prophylactic measures, such as antimicrobial and antiviral agents as well as vaccinations following treatments are mandatory (such as in the first six months following ASCT or CAR-T cell therapy to reduce the risk of infections and their associated complications). 63 Additionally, intravenous immunoglobulin (IVIG) substitution therapy should be considered in most cases, 82 especially in patients treated with CAR-T cell therapy and bispecific antibodies. IVIG, derived from pooled human plasma, contains antibodies that provide passive immunity against various infectious agents.…”

Section: The Role Of Supportive Care In Achieving Curementioning

confidence: 99%

Functional cure and long-term survival in multiple myeloma: how to challenge the previously impossible

Engelhardt,

Kortüm,

Goldschmidt

et al. 2024

haematol

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Multiple myeloma (MM) is a heterogeneous disease with survival ranging from months to decades. The goal of ‘cure’ remains elusive for most patients, but has been shown to be possible, with durable remission and a transition to a plateau phase (analogous to monoclonal gammopathy of uncertain significance/smoldering Myeloma (MGUS/SMM)). Two representative cases set the stage to illustrate how this might be possible and what still needs to be determined to achieve functional disease control over a prolonged period. Several developments have emerged, such as improved diagnostics including the definitions and use of SLiM-CRAB criteria and MRD with whole genome- /single-cell-sequencing as well as other correlates to better understand disease biology. These advances enable earlier detection, more accurate risk stratification and improved personalized treatment strategies by facilitating analysis of genetic alterations and clonal heterogeneity. Whole genome sequencing may also identify driver mutations and modes of resistance to targets like immunotherapies (IOs) as well as other targeted therapies. Today, induction with a CD38 antibody (CD38mAb), proteasome inhibitor, immunomodulatory drug, and dexamethasone, potentially followed by ASCT and lenalidomide maintenance, can be considered standard of care for transplant-eligible (TE) newly diagnosed (NDMM) patients. Whether prolonged disease control and functional cure can be achieved in non-transplant eligible (NTE) patients is currently emerging as a distinct possibility: data from phase III trials that incorporate a CD38mAb into the treatment of NTE NDMM patients demonstrate impressive MRD negativity rates that appear sustained over several years. While the long-term durability of CAR-Ts, bi-specific antibodies and other IOs are evaluated, several clinical trials are now investigating their role in frontline treatment for TE and NTE patients. These will address whether CAR-Ts will replace ASCT and whether such IOs will represent a truly curative option. We conclude that whilst cure remains elusive, the concept of operational or functional cure provides a new benchmark to strive for and is an emerging area of active and potentially achievable clinical research for MM.

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Expert Consensus on the Incorporation of Anti-CD38 Monoclonal Antibody Therapy Into the Management of Newly Diagnosed Multiple Myeloma

Lonial

Bowser²,

Chari

et al. 2023

Clinical Lymphoma Myeloma and Leukemia

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Intravenous Immunoglobulin Prophylaxis Is Associated with Decreased Rate of Infection-Related Hospitalizations in Multiple Myeloma Patients

Cited by 4 publications

References 0 publications

Chronic inflammatory demyelinating polyneuropathy with pulmonary nocardiosis: A case report

Chronic inflammatory demyelinating polyneuropathy with pulmonary nocardiosis: A case report

Functional cure and long-term survival in multiple myeloma: how to challenge the previously impossible

Expert Consensus on the Incorporation of Anti-CD38 Monoclonal Antibody Therapy Into the Management of Newly Diagnosed Multiple Myeloma

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