Elsevier

Blood Reviews

Volume 32, Issue 2, March 2018, Pages 106-115
Blood Reviews

Review
Immunoglobulin therapy in hematologic neoplasms and after hematopoietic cell transplantation

https://doi.org/10.1016/j.blre.2017.09.003Get rights and content
Under a Creative Commons license
open access

Abstract

Immunoglobulins are used to prevent or reduce infection risk in primary immune deficiencies and in settings which exploit its anti-inflammatory and immune-modulatory effects. Rigorous proof of immunoglobulin efficacy in persons with lympho-proliferative neoplasms, plasma cell myeloma, and persons receiving hematopoietic cell transplants is lacking despite many clinical trials. Further, there are few consensus guidelines or algorithms for use in these conditions. Rapid development of new therapies targeting B-cell signaling and survival pathways and increased use of chimeric antigen receptor T-cell (CAR-T) therapy will likely result in more acquired deficiencies of humoral immunity and infections in persons with cancer. We review immunoglobulin formulations and discuss efficacy and potential adverse effects in the context of preventing infections and in graft-versus-host disease. We suggest an algorithm for evaluating acquired deficiencies of humoral immunity in persons with hematologic neoplasms and recommend appropriate use of immunoglobulin therapy.

Keywords

Intravenous immunoglobulin
Subcutaneous immunoglobulin
Hypogammaglobulinemia
Chronic lymphocytic leukemia
Lymphoma
Myeloma
Hematopoietic cell transplantation
Anaphylaxis
CAR-T therapy
B-cell signaling and survival pathways.

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