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 in the Adjunct Treatments section of its Myeloma guideline says that IVIG therapy should be considered in the setting of recurrent life-threatening infections. The 2012 UK guideline makes similar recommendations.

 

NCCN, Supportive Care 2018

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.

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