Clinic for Medical Oncology and Haematology, Winterthur Cantonal Hospital, Winterthur, Switzerland.
Department of Oncology and Haematology, Lindenhofgruppe (Prolindo), Berne, Switzerland.
Swiss Med Wkly. 2024 Sep 9;154:3559. doi: 10.57187/s.3559.
Immunoglobulins for intravenous use (IVIgs) and subcutaneous use (SCIgs) can prevent recurrent and severe infections in patients with secondary antibody deficiencies that are frequently linked to haematological/oncological malignancies as well as other clinical conditions and their respective treatments. Even so, as IVIgs and SCIgs are costly and their supply is limited, their clinical use must be optimised. The aim of this position paper is to provide structured practical guidance on the optimal use of IVIgs and SCIgs in secondary antibody deficiencies, particularly in haematological and oncological practice. The authors agree that the occurrence of severe infections is a prerequisite for the use of IVIgs. Serum IgG levels in general as well as IgG subclass levels can be additional indicators of whether a patient could benefit from IVIgs. Responsiveness to vaccines can help to identify immunodeficiency. Patients with chronic lymphocytic leukaemia or multiple myeloma who are receiving respective treatment, especially B-cell depletion therapy, but also some patients with autoimmune diseases are prone to antibody deficiencies and need IVIgs. For the optimal use of IVIgs and to maximise their potential benefit, the indication must be individually assessed for each patient. As a primary treatment goal, the authors define a sufficient prophylaxis of severe infections, which can be supported by normalising IgG levels. If the initiated treatment is insufficient or linked to intolerable adverse reactions, switching the product within the class of IVIgs or changing to a different batch of the same product can be considered. Pausing treatment can also be considered if there are no infections, which happens more frequently in summer, but treatment needs to be resumed once infections return. These structured recommendations for IVIg treatment in patients with secondary antibody deficiency may provide guidance for clinical practice and therefore help to allocate IVIgs to those who will benefit the most, without overusing valuable resources.
静脉用免疫球蛋白（IVIg）和皮下用免疫球蛋白（SCIg）可预防与血液/肿瘤恶性肿瘤以及其他临床病症及其治疗相关的继发性抗体缺陷患者的复发性和严重感染。即便如此，由于 IVIg 和 SCIg 成本高昂且供应有限，因此必须优化其临床应用。本立场文件旨在为继发性抗体缺陷患者，特别是血液学和肿瘤学实践中 IVIg 和 SCIg 的最佳使用提供结构化的实用指导。作者们一致认为，严重感染的发生是使用 IVIg 的前提。一般而言，血清 IgG 水平以及 IgG 亚类水平可以作为患者是否可能从 IVIg 中受益的附加指标。疫苗反应性有助于确定免疫缺陷。正在接受相应治疗的慢性淋巴细胞白血病或多发性骨髓瘤患者，尤其是接受 B 细胞耗竭治疗的患者，但也有一些患有自身免疫性疾病的患者容易发生抗体缺陷并需要 IVIg。为了优化 IVIg 的使用并最大程度地发挥其潜在益处，必须为每位患者单独评估适应症。作为主要的治疗目标，作者们将充分预防严重感染定义为目标，这可以通过使 IgG 水平正常化来支持。如果启动的治疗不足或与无法耐受的不良反应相关，则可以考虑在 IVIg 类别内更换产品或更改同一产品的不同批次。如果没有感染，也可以暂停治疗，这种情况在夏季更为常见，但一旦感染恢复，就需要重新开始治疗。这些针对继发性抗体缺陷患者 IVIg 治疗的结构化建议可为临床实践提供指导，从而有助于将 IVIg 分配给最受益的患者，而不会过度使用宝贵的资源。
