Contributions
Abstract: PB1652
Type: Publication Only
Background
Intravenous Immunoglobulin (IVIG) is widely used in primary immune syndrome cases due to the high risk of infection associated with hypogammaglobulinemia. For the last two decades, immunoglobulin replacement therapy has been used to treat lymphoproliferative diseases which cause secondary antibody deficiency, and also to treat hematological diseases, such as multiple myeloma. In malignancies, iatrogenic hypogammaglobulinemia is associated with chemo-immunotherapy regimens (anti-CD20 therapy), immunosuppressive therapies (steroid, mycophenolate mofetil) and chemotherapeutic agents (cyclophosphamide, fludarabine), and in such patients, serious infection attacks may occur that are associated with the dysregulation of the immune system and hypogammaglobulinemia.
Aims
This study involves the initiation of IVIG prophylaxis in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) who were treated and followed-up by our team, who had frequent and life-threatening infections and who had decreased immunoglobulin levels when compared to their pre-treatment levels. This report contains the results of our preliminary study.
Methods
Pediatric hematology-oncology patients diagnosed with ALL between 2010 and 2017, presenting with no immunodeficiency at the time of diagnosis and receiving treatment based on the St. Jude Total XV chemotherapy protocol were enlisted in this study. Repetitive infection attacks, multiple neutropenic infection incidences per month, chemotherapy interruptions of longer than one month, age-adjusted drops in immunoglobulin levels below -2SD or by more than half of the immunoglobulin levels at the time of diagnosis were accepted as IVIG prophylaxis initiation criteria. Regular IVIG prophylaxis of 0.5 gr/kg at three-week intervals was initiated for these patients.
Results
Of the five patients, who were enrolled in the program, three were male and two were female. The patients were followed up with a high-risk ALL diagnosis, and that the findings showed that one patient had T-cell ALL and the others had B-cell ALL. The age range of patients was 10 months to six years. It was observed that incidences of neutropenic infection in patients that require hospitalization following prophylaxis decreased, and their treatment continued without interruption.
Conclusion
After IVIG prophylaxis, incidences of neutropenic infection in our patients were seen to decrease, and as a result of this decrease, our patients were provided with regular and continuous treatment. There are very few studies in the literature that involved IVIG prophylaxis in pediatric leukemia patients with secondary hypogammaglobulinemia. Being a preliminary study at its current stage, the collection of data related to this study is continuing.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Immunoglobulin
Abstract: PB1652
Type: Publication Only
Background
Intravenous Immunoglobulin (IVIG) is widely used in primary immune syndrome cases due to the high risk of infection associated with hypogammaglobulinemia. For the last two decades, immunoglobulin replacement therapy has been used to treat lymphoproliferative diseases which cause secondary antibody deficiency, and also to treat hematological diseases, such as multiple myeloma. In malignancies, iatrogenic hypogammaglobulinemia is associated with chemo-immunotherapy regimens (anti-CD20 therapy), immunosuppressive therapies (steroid, mycophenolate mofetil) and chemotherapeutic agents (cyclophosphamide, fludarabine), and in such patients, serious infection attacks may occur that are associated with the dysregulation of the immune system and hypogammaglobulinemia.
Aims
This study involves the initiation of IVIG prophylaxis in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) who were treated and followed-up by our team, who had frequent and life-threatening infections and who had decreased immunoglobulin levels when compared to their pre-treatment levels. This report contains the results of our preliminary study.
Methods
Pediatric hematology-oncology patients diagnosed with ALL between 2010 and 2017, presenting with no immunodeficiency at the time of diagnosis and receiving treatment based on the St. Jude Total XV chemotherapy protocol were enlisted in this study. Repetitive infection attacks, multiple neutropenic infection incidences per month, chemotherapy interruptions of longer than one month, age-adjusted drops in immunoglobulin levels below -2SD or by more than half of the immunoglobulin levels at the time of diagnosis were accepted as IVIG prophylaxis initiation criteria. Regular IVIG prophylaxis of 0.5 gr/kg at three-week intervals was initiated for these patients.
Results
Of the five patients, who were enrolled in the program, three were male and two were female. The patients were followed up with a high-risk ALL diagnosis, and that the findings showed that one patient had T-cell ALL and the others had B-cell ALL. The age range of patients was 10 months to six years. It was observed that incidences of neutropenic infection in patients that require hospitalization following prophylaxis decreased, and their treatment continued without interruption.
Conclusion
After IVIG prophylaxis, incidences of neutropenic infection in our patients were seen to decrease, and as a result of this decrease, our patients were provided with regular and continuous treatment. There are very few studies in the literature that involved IVIG prophylaxis in pediatric leukemia patients with secondary hypogammaglobulinemia. Being a preliminary study at its current stage, the collection of data related to this study is continuing.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, Immunoglobulin