IVIG in Waldenstrom’s – pro
The hypogammaglobinemia and impaired T-cell function associated with Waldesntrom’s macroglobulinemia predispose patients to potentially serious infections. CLL is a similar condition to Wandenstrom’s and is much more common. IVIG is well established for CLL. UNfortunately, it is not similarly establisehd for Waldesntrom’s. IgA and IgG hypogammaglobulinemia is common in Waldenström’s macroglobulinemia and persists despite therapeutic intervention and response. A recent review found that IgA and IgG hypogammaglobulinemia does not predict the risk of recurrent infections in patients with Waldenström’s macroglobulinemia, although lower levels of serum IgA and IgG are associated with disease progression in Waldenström’s macroglobulinemia patients being managed with a ‘watch and wait’ strategy.
NCCN does not mention IVIG as an adjunctive or primary treatment. More recenlty, IVIG was reported to prevent Rituxan induced flair.
Silvia Sánchez-Ramón,et al, Challenges in the Role of Gammaglobulin Replacement Therapy and Vaccination Strategies for Hematological Malignancy. Front Immunol. 2016; 7: 317.
Stephen M. Ansell, MD, PhD, Robert A. Kyle, MD, Craig B. Reeder, MD, Rafael Fonseca, MD, Joseph R. Mikhael, MD, William G. Morice, MD, PhD, P. Leif Bergsagel, MD, Francis K. Buadi, MD, Joseph P. Colgan, MD, David Dingli, MD, PhD, Angela Dispenzieri, MD, Philip R. Greipp, MD, Thomas M. Habermann, MD, Suzanne R. Hayman, MD, David J. Inwards, MD, Patrick B. Johnston, MD, Shaji K. Kumar, MD, Martha Q. Lacy, MD, John A. Lust, MD, PhD, Svetomir N. Markovic, MD, PhD, Ivana N. M. Micallef, MD, Grzegorz S. Nowakowski, MD, Luis F. Porrata, MD, Vivek Roy, MD, Stephen J. Russell, MD, PhD, Kristen E. Detweiler Short, RN, CNP, A. Keith Stewart, MD, Carrie A. Thompson, MD, Thomas E. Witzig, MD, Steven R. Zeldenrust, MD, PhD, Robert J. Dalton, MD, S. Vincent Rajkumar, MD, and Morie A. Gertz, MD
Diagnosis and Management of Waldenström Macroglobulinemia: Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) Guidelines ayo Clin Proc. 2010 September; 85(9): 824–833.
Zachary R. Hunter1 et al, IgA and IgG hypogammaglobulinemia in Waldenström’s macroglobulinemia haematol March 1, 2010 vol. 95 no. 3 470-475