Immunoglobulin replacement in patients with chronic lymphocytic leukemia and multiple myeloma

Abstract

Infections play an important role in the mortality of patients with chronic lymphocytic leukemia (CLL) and plasma cell myeloma (PMC). Susceptibility to infections in CLL and MM results from complex defects of humoral and cell-mediated immunity including hypogammaglobulinemia. Potential methods of prevention of bacterial infections in CLL and PCM include vaccination against Streptococcus pneumoniae and Haemophilus influenzae, prophylactic use of antibiotics and intravenous or subcutaneous polyclonal immunoglobulin (IG) replacement. Majority of clinical trials evaluating IG substitution strategy in CLL and MM that were mainly performed in 1980’ and 1990’, have shown significant reduction in number of bacterial infections. However, IG replacement has not been associated with prolonged patients’ survival while it carries important costs to healthcare systems. Based on these findings, prophylactic IG replacement therapy is mainly indicated in selected patients with high risk of infectious complications, especially those with hypogammaglobulinemia and history of severe or recurrent bacterial infections. In this paper we propose practical rules of IG replacement therapy in CLL and PMC.