Longitudinal study of intravenous versus subcutaneous immunoglobulin replacement therapy in hematological malignancy

Abstract

Aim:To present findings from a longitudinal study on infection risk, mortality, and patient perspective of intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) treatment for patients with hypogammaglobulinemia secondary to hematological malignancy or its treatment (abbreviated as SID).Methods: Observational study period included final year of IVIg (13 patients) and of the first 3 years of SCIg (17 patients) with SID. Data were collected on clinical outcomes from medical records and patient perception via study specific questionnaire. Results:The median age was 63 years (53-76 years), and for 82.4% of patients their hematological malignancy was in complete remission. The annual mean serum IgG trough levels remained stable over the 4 years and were 7.0 g/L (±2.77 g/L) with IVIg, and 8.0 g/L (±1.75 g/L), 8.7 g/L (±2.75 g/L), and 7.6 g/L (±2.89 g/L) (year 1, 2, and 3, respectively) with SCIg. While the annual infection rate was similar, the rate of hospitalization due to infection fluctuated, with 37%, 9%, 15%, and 32% in year 1, 2, 3, and 4 respectively. There were no systemic adverse events with IVIg or SCIg. Patients reported a strong preference for SCIg. One patient died due to progression of underlying disease and infection within the study period. Conclusion:SCIg was the preferred treatment mode over IVIg in our cohort, but both were well tolerated without any systemic adverse events in 4-year follow up. The dosage and serum IgG levels were stable throughout. However, the number of infections requiring hospitalization fluctuated. It is anticipated that these findings encourage more hospitals to offer SCIg for SID patients.

Evaluation of immunoglobulin replacement therapy in secondary immunodeficiency at three British Columbia hospitals

“…This may reflect clinician experience managing immunodeficiencies, as SCIg use is more common in PID. Although SCIg in PID provides higher trough IgG levels at similar doses to IVIg, in the SIGNS study and a prospective Australian study comparing IVIg and SCIg patients with SID, patients had similar Ig doses, mean trough IgG levels and annual infection rates [3, 29, 30]. However, the SCIg cohorts were small, and larger studies in the SID population are needed to assess whether SCIg could improve overall Ig utilization.…”

Exploring preferences of different modes of administration of hypomethylating agent treatments among patients with acute myeloid leukemia

“…Both intravenous (IV) and subcutaneous (SC) versions of HMAs have been approved for use in Europe, and current HMAs are required to be administered by healthcare professionals ( 12 ). Studies conclude that while both administration methods are effective, with no notable difference in tolerability, patients usually prefer the SC route ( 15 , 16 ). The reasons are likely that the SC administration requires a shorter time commitment from the patient ( 17 – 19 ) and perceived to cause less pain and discomfort than the IV route ( 20 ).…”

“…HMAs are usually administered parenterally for 5-7 days per 28-day treatment cycle, with several treatment cycles necessary to achieve a response (9,(11)(12)(13). While the side effects of HMAs are milder than those of SIC, patients might experience myelosuppression (fatigue, increased risk of infection, neutropenic fever), gastrointestinal problems (nausea, diarrhea, constipation) and -for those who receive HMAs subcutaneously -injection site-related side effects (14). Both intravenous (IV) and subcutaneous (SC) versions of HMAs have been approved for use in Europe, and current HMAs are required to be administered by healthcare professionals (12).…”