Department of Medicine, Clinical Immunology and Hematology, University of Padova , Padova , Italy.
Front Immunol. 2014 Dec 8;5:626. doi: 10.3389/fimmu.2014.00626. eCollection 2014.
Immunoglobulin (Ig) replacement therapy dramatically changed the clinical course of primary hypogammaglobulinemias, significantly reducing the incidence of infectious events. Over the last two decades its use has been extended to secondary antibody deficiencies, particularly those related to hematological disorders as lymphoproliferative diseases (LPDs) and multiple myeloma. In these malignancies, hypogammaglobulinemia can be an intrinsic aspect of the disease or follow chemo-immunotherapy regimens, including anti-CD20 treatment. Other than in LPDs the broadening use of immunotherapy (e.g., rituximab) and immune-suppressive therapy (steroids, sulfasalazine, and mycophenolate mofetil) has extended the occurrence of iatrogenic hypogammaglobulinemia. In particular, in both autoimmune diseases and solid organ transplantation Ig replacement therapy has been shown to reduce the rate of infectious events. Here, we review the existing literature about Ig replacement therapy in secondary hypogammaglobulinemia, with special regard for subcutaneous administration route, a safe, effective, and well-tolerated treatment approach, currently well established in primary immunodeficiencies and secondary hypogammaglobulinemias.
免疫球蛋白（Ig）替代疗法显著改变了原发性低丙种球蛋白血症的临床病程，显著降低了感染事件的发生率。在过去的二十年中，它的应用已经扩展到继发性抗体缺陷，特别是那些与血液系统疾病相关的，如淋巴增殖性疾病（LPDs）和多发性骨髓瘤。在这些恶性肿瘤中，低丙种球蛋白血症可能是疾病的内在表现，也可能是化疗免疫治疗方案的结果，包括抗 CD20 治疗。除了在 LPDs 中，免疫疗法（例如利妥昔单抗）和免疫抑制疗法（类固醇、柳氮磺胺吡啶和霉酚酸酯）的广泛应用扩大了医源性低丙种球蛋白血症的发生。特别是在自身免疫性疾病和实体器官移植中，Ig 替代疗法已被证明可以降低感染事件的发生率。在这里，我们回顾了关于继发性低丙种球蛋白血症的 Ig 替代疗法的现有文献，特别关注皮下给药途径，这是一种安全、有效和耐受良好的治疗方法，目前在原发性免疫缺陷和继发性低丙种球蛋白血症中得到了很好的应用。
