Prophylactic intravenous immunoglobulin during autologous haemopoietic stem cell transplantation for multiple myeloma is not associated with reduced infectious complications

Abstract

Patients with multiple myeloma undergoing autologous haemopoietic stem cell transplantation (ASCT) are at high risk for infectious complications. Peri-transplant intravenous immunoglobulin (IVIG) has been used with the aim of reducing these risks. Our retrospective, non-randomised study of peri-transplant IVIG use and effect on infectious complications in 266 ASCTs for myeloma from 2000 to 2009 at a major metropolitan referral centre for haematological malignancies found no difference between those receiving peri-transplant IVIG (0.4 g/kg) (n=130) and those who were not (n=110) with regard to bloodstream infections, pneumonia, urinary tract or gastrointestinal infections. When analysed according to pre-transplant therapy (conventional chemotherapy versus novel agents), there was no significant difference in infectious complications between those who did or did not receive peri-transplant IVIG. In conclusion, our study did not show a benefit for the use of peri-transplant IVIG (0.4 g/kg) to reduce infectious complications in a large cohort of patients with myeloma undergoing ASCT. In the absence of data supporting efficacy in this context, there appears to be no benefit in the routine use of IVIG for this purpose.

Risks, severity and timing of infections in patients with multiple myeloma: a longitudinal cohort study in the era of immunomodulatory drug therapy

“…Infections remain a leading contributor to morbidity and mortality in patients with MM and the patterns and risk factors for infection have changed over time with the evolution of MM therapies (Teh et al , ) (Blimark et al , ) (Cesana et al , ; Blombery et al , ; Kim et al , ). There is a need to establish the impact of current therapies on risk and pattern of infection, which is not able to be fully evaluated in registry studies (Blimark et al , ).…”

“…*Adjusted HR accounts for all the listed clinical variables by conditional risk set modelling.†Regimens include vincristine-doxorubicin-dexamethasone (VAD) and dexamethasone-doxorubicin-cyclophosphamide-etoposide (D-PACE) AE thalidomide or lenalidomide. ‡Prednisolone equivalent.Patterns and Risks of Infection in Patients with Myeloma ª 2015 John Wiley & Sons Ltd of MM therapies (Teh et al, 2014a) (Blimark et al, 2015)(Cesana et al, 2003;Blombery et al, 2011;Kim et al, 2012).…”

Update on the use of immunoglobulin in human disease: A review of evidence

“…83 On the other hand, 2 retrospective, nonrandomized reviews did not show benefit of IVIG in the peritransplantation period in MM (n 5 266 autologous stem cell transplantation from 2000-2009; n 5 166 autologous stem cell transplantation from 2008-2013). 84,85 Given the state of the evidence, the current review panel recommends that patients with MM and recurrent serious bacterial infections who have subprotective antibody levels following immunization against diphtheria, tetanus, or pneumococcal infection be considered eligible for immunoglobulin replacement therapy, as in CLL.…”

Challenges in the Role of Gammaglobulin Replacement Therapy and Vaccination Strategies for Hematological Malignancy

“…The use of IVIg prophylaxis in hematopoietic stem cell transplantation (HSCT) for MM patients without selection by immunological parameters has shown beneficial results in terms of quality of life, but does not seem to affect CMV infection incidence or other infectious complications (127–129). …”