Secondary immunodeficiencies with predominant antibody deficiency: multidisciplinary perspectives of Polish experts

Jahnz-Różyk, Karina; Więsik-Szewczyk, Ewa; Roliński, Jacek; Siedlar, Maciej; Jędrzejczak, Wiesław Wiktor; Sydor, Wojciech; Tomaszewska, Agnieszka

doi:10.5114/ceji.2020.101265

Cited by 5 publications

(7 citation statements)

References 75 publications

(132 reference statements)

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“…Notably, the consensus found in this survey aligns closely with the recommendations outlined in existing guidelines, illustrating the significant coherence between clinical practice and established directives [13,14,28,[31][32][33].…”

Section: Discussionsupporting

confidence: 69%

“…The adequate management of these patients in routine daily practice is challenging for different reasons, including the lack of standardized protocols and disparities related to appropriate vaccination coverage and immunization schedules and the use of antibiotic prophylaxis. There are also uncertainties regarding when to initiate therapy or when to discontinue IgRT [28,29].…”

Section: Discussionmentioning

confidence: 99%

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Current Approach in the Management of Secondary Immunodeficiency in Patients with Hematological Malignancies: Spanish Expert Consensus Recommendations

Boqué,

Sánchez-Ramón,

Córdoba

et al. 2023

JCM

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A Delphi-based survey was designed to assess the opinions of clinical hematologists (n = 17) and clinical immunologists (n = 18) from across Spain on secondary immunodeficiencies (SID) in the management of oncohematological patients. There was 100% agreement on the need to have available guidelines for the management of immunodeficiency in hematological patients; to perform a baseline immunological evaluation in patients with chronic lymphocytic leukemia (CLL), multiple myeloma (MM), lymphoma and hematopoietic stem cell transplantation (HSCT) recipients; and to quantify serum IgG, IgA and IgM levels when SID is suspected. More than 90% agreed on the need for active immunization against seasonal influenza and H1N1, pneumococcus and Haemophilus influenzae. There was a consensus on the monitoring of IgG levels every 3 months (83%) and the need to have available a clinical protocol for the use of IVIG in the management of SID (94%), to monitor trough IgG levels to determine the correct IVIG dose (86%) and to discontinue IVIG after the recovery of IgG levels after 12 months of follow-up (77%). The findings of the present survey may be useful recommendations for hematologists and immunologists to improve the management of SID in daily practice.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Current Approach in the Management of Secondary Immunodeficiency in Patients with Hematological Malignancies: Spanish Expert Consensus Recommendations

Boqué,

Sánchez-Ramón,

Córdoba

et al. 2023

JCM

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“…Similar results were obtained in the UK [ 1 ] where SID appears to be increasing the demand for IgGRT. Recommendations for SID treatment differ worldwide, and in Poland, they are not strictly described [ 25 ]. Moreover, home SCIG therapy is not reimbursed for patients with SID in Poland.…”

Section: Discussionmentioning

confidence: 99%

Increased Access to Immunoglobulin Replacement Therapy for Patients with Primary Immunodeficiency in Poland Based on Clinical Usage Data of Immunoglobulin G over a 5-Year Period

Więsik-Szewczyk

Ziętkiewicz

Radziwilska-Muc

et al. 2023

JCM

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Owing to the rising popularity and demand for immunoglobulins (IgG), obtaining supplies and rationalizing IgG use have become challenging. Herein, IgG consumption in Poland was analyzed through total IgG use and number of patients reported to the National Health Fund between 1 January 2016 and 31 December 2020. Total IgG used within 5 years increased by 27.48%, IgG use/1000 inhabitants/year was 23.13 g (2016) and 29.61 g (2020). In 2020, 35.5 % of IgG used was for neurological conditions, 25% for primary immunodeficiencies (PID), and 39.3% for all other indications. Within 5 years, 1,121,168.75 g IgG was used in PID; the use increased by 72%, from 783 in 2016 to 1153 patients in 2020. The proportion of patients who received subcutaneous immunoglobulin (SCIG) replacement therapy (IgRT) increased to 78% (2020). Within 5 years, 1,783,534.81 g IgG was used in neurological drug programs (+42.44%) and 2,327,513.88 g (+1.25%) outside neurological indications and outside PID. The annual IgG amount decreased in adult anesthesiology and intensive care (−46%), internal medicine (−55%), pneumonology (−50%), pediatric clinical immunology (−50%), and gynecology and obstetrics (−48%) and increased in dermatology (+178%), rheumatology (+103%), and clinical transplantation (+82%). IgG use significantly increased in Poland, mostly owing to PID. Subcutaneous IgG administration is currently the most common mode of IgRT in PID patients. An increase in SCIG administration may be expected for other indications. Implementing evidence-based clinical guidelines is key to prioritizing and rationalizing IgG use for immunomodulatory indications and secondary immune deficiencies.

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“…Many studies have focused on the use of IGRT; nevertheless, this intervention may not be based solely on IG levels [96][97][98][99]. The administration of IVIG in patients seems to reduce the incidence of infectious complications but not affect mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Secondary Dysgammaglobulinemia in Children with Hematological Malignancies Treated with Targeted Therapies

Tragiannidis

Groll

2021

Pediatr Drugs

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Targeted therapies have emerged as innovative treatments for patients whose disease does not respond to conventional chemotherapy, and their use has widely expanded in the field of pediatric hematologic malignancies in the last decade. While they carry the promise of improved disease control and survival and are currently investigated in first-line treatment protocols for patients with poor prognostic markers, they are associated with a considerable incidence of specific toxicities, including cytokine-release syndrome, neurotoxicity, hepatotoxicity, nephrotoxicity, cardiotoxicity, endocrine adverse events, and infectious complications. Iatrogenic or secondary dysgammaglobulinemia is a main consequence of targeted therapies using monoclonal antibodies and other antibody-derived treatments that target specific antigens on lymphoid cells (blinatumomab, inotuzumab ozogamicin, rituximab), chimeric antigen receptor T cells, tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib) and, to a lesser extent, checkpoint inhibitors (pembrolizumab, nivolumab). This review discusses the diagnosis and incidence of secondary or iatrogenic dysgammaglobulinemia in children treated with targeted therapies for leukemias and lymphomas, and options for monitoring and treatment.

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Secondary immunodeficiencies with predominant antibody deficiency: multidisciplinary perspectives of Polish experts

Cited by 5 publications

References 75 publications

Current Approach in the Management of Secondary Immunodeficiency in Patients with Hematological Malignancies: Spanish Expert Consensus Recommendations

Current Approach in the Management of Secondary Immunodeficiency in Patients with Hematological Malignancies: Spanish Expert Consensus Recommendations

Increased Access to Immunoglobulin Replacement Therapy for Patients with Primary Immunodeficiency in Poland Based on Clinical Usage Data of Immunoglobulin G over a 5-Year Period

Secondary Dysgammaglobulinemia in Children with Hematological Malignancies Treated with Targeted Therapies

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