IVIG for multiple myeloma/ prophylaxis – pro
Role of IVIG in prophylaxis of infection in multiple myeloma is now well accepted. One systematic review found that immunoglobulin reduced infections, although they may increase toxicity. There have been two older randomzed controlled studies (RCT). One RCT found no difference in proportion of people with infections between gamma globulin and albumin control at 19 months (48 people; 7/17 [41%] with gamma globulin v 8/24 [33%] with albumin control; significance not reported). The other RCT found that intravenous immunoglobulin significantly reduced serious infections compared with placebo at 1 year (83 people; number of episodes: 19 with immunoglobulin v 38 with placebo; P = 0.019).
A 2007 guideline did not recommend use of IVIG in multiple myeloma. However NCCN 2022 says that, “it should be considered in the setting of recurrent (<200mg.dL) infections". Other refernces The 2012 UK guideline makes similar recommendations.
NCCN, Multiple Myeloma NYEL-H 2022
Anderson D, Ali K, Blanchette V, Brouwers M, Couban S, Radmoor P, et al. Guidelines on the use of intravenous immune globulin for hematologic conditions. Transfus Med Rev (2007) 21:S956.
Nicolò Compagno et al, Immunoglobulin Replacement Therapy in Secondary HypogammaglobulinemiaFront Immunol. 2014; 5: 626.
G. Lancman et al, Efficacy of Intravenous Immunoglobulin for Preventing Infections in Patients with Multiple Myeloma. Clinical Lymphoma Myeloma and Leukemia Volume 21, Issue 5, May 2021, Pages e470-e476