Baek Dong Won, Song Ga-Young, Lee Ho Sup, Do Young Rok, Lee Ji Hyun, Yhim Ho-Young, Moon Joon Ho, Yang Deok-Hwan
Department of Hematology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Hematology, Chonnam National University Hwasun Hospital, Chollanamdo, Republic of Korea.
Front Oncol. 2024 Apr 23;14:1380492. doi: 10.3389/fonc.2024.1380492. eCollection 2024.
Elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) undergoing reduced intensity R-CHOP therapy are at a heightened risk of acquiring infections, notably coronavirus disease 2019 (COVID-19) infection. This study aimed to evaluate the efficacy of intravenous immunoglobulin (IVIG) as prophylaxis against COVID-19 in this vulnerable population.
A total of 125 elderly patients with DLBCL undergoing reduced intensity R-CHOP therapy were analyzed in this prospective, multicenter study. Patients with hypogammaglobulinemia were categorized into IVIG and non-IVIG groups, while those with normal immunoglobulin levels constituted the observation group. The study evaluated COVID-19 infection rates, therapy response, and safety outcomes.
Among the enrolled patients (median age: 77 years), 89 patients (71.2%) presented with hypogammaglobulinemia at diagnosis, and 56 patients enrolled in the IVIG administration group. IVIG administration remarkably reduced COVID-19 infection rates compared to non-IVIG recipients (8.9% vs. 24.6%; p =0.040). Notably, patients over 80 years old were more susceptible to COVID-19. Patients on IVIG exhibited good tolerance with manageable adverse events. Among patients with hypogammaglobulinemia who received IVIG, 40.5% of patients developed additional immunoglobulin deficiencies during chemotherapy. One or more new hypogammaglobulinemia occurred during chemotherapy in 72% of patients with hypogammaglobulinemia who did not receive IVIG, and in 61.3% of patients who did not have hypogammaglobulinemia at diagnosis.
IVIG showed promise in reducing COVID-19 infections among elderly patients with DLBCL receiving reduced intensity R-CHOP therapy. This highlights IVIG's potential as a prophylactic measure, necessitating further investigation to optimize dosing, administration schedules, and potential interactions with vaccination strategies.
诊断为弥漫性大B细胞淋巴瘤（DLBCL）且正在接受低强度R-CHOP治疗的老年患者感染风险增加，尤其是感染2019冠状病毒病（COVID-19）。本研究旨在评估静脉注射免疫球蛋白（IVIG）在这一脆弱人群中预防COVID-19的疗效。
在这项前瞻性多中心研究中，共分析了125例接受低强度R-CHOP治疗的老年DLBCL患者。低丙种球蛋白血症患者分为IVIG组和非IVIG组，免疫球蛋白水平正常的患者组成观察组。该研究评估了COVID-19感染率、治疗反应和安全性结果。
在入组患者（中位年龄：77岁）中，89例（71.2%）在诊断时出现低丙种球蛋白血症，56例患者纳入IVIG给药组。与未接受IVIG的患者相比，IVIG给药显著降低了COVID-19感染率（8.9%对24.6%；p=0.040）。值得注意的是，80岁以上的患者更容易感染COVID-19。接受IVIG的患者耐受性良好，不良事件可控。在接受IVIG的低丙种球蛋白血症患者中，40.5%的患者在化疗期间出现了额外的免疫球蛋白缺乏。在未接受IVIG的低丙种球蛋白血症患者中，72%的患者在化疗期间出现一种或多种新的低丙种球蛋白血症，在诊断时无低丙种球蛋白血症的患者中，这一比例为61.3%。
IVIG在降低接受低强度R-CHOP治疗的老年DLBCL患者的COVID-19感染方面显示出前景。这突出了IVIG作为一种预防措施的潜力，需要进一步研究以优化给药剂量、给药方案以及与疫苗接种策略的潜在相互作用。
