title: Retrospective analysis of weekly intravenous immunoglobulin prophylaxis versus intravenous immunoglobulin by IgG level monitoring in hematopoietic stem cell transplant recipients.
abstract: Patients undergoing allogeneic hematopoietic stem cell transplant (allo HCT) have a higher incidence of infections partly due to secondary hypogammaglobulinemia. We evaluated the role of IVIG in allo HCT patients who received prophylactic IVIG 200 mg/kg once weekly regardless of IgG level (Group 1, n = 115) compared with patients who received IVIG based on IgG level <400 mg/dL (Group 2, n = 114). Primary endpoints were the utilization of IVIG, incidence of veno-occlusive disease (VOD), graft-versus-host disease (GVHD), and documented infections within the first 100 days after allo HCT. Patients in both groups were similar except for a higher number of matched unrelated donor (MUD) transplants in Group 2 (62 vs. 41, P = 0.01). There were no significant differences in the incidence all grades of GVHD (55 vs. 50), VOD (2 vs. 0) or infections in the two groups except for a higher incidence of para-influenza infections in group 1 (9 vs. 0, P = 0.003) coinciding with the flu season. We recommend monthly monitoring of IgG level and replacement only if IgG level is <400 mg/dL.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Howell
authors.forename: Alison M
authors.initials: AM
authors.lastname: Gulbis
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
mesh_terms: D000293:Adolescent; D000328:Adult; D000361:Agammaglobulinemia / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018108:Respirovirus / Q000254:growth & development*; D010253:Respirovirus Infections / Q000097:blood / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D016756:Immunoglobulins, Intravenous