The use of intravenous immunoglobulin (IVIG) may provide benefit against infections in subgroups of patients with multiple myeloma (MM), according to a retrospective, single-center crossover study that compared rates of infection in patients with MM during observation compared with those receiving IVIG. The study results were published in Clinical Lymphoma, Myeloma & Leukemia.
According to the study authors, prophylactic IVIG is often used in patients with MM to prevent infections; however, data supporting this practice are limited. To explore the use of IVIG further, the researchers looked at outcomes from 68 patients with MM who were treated with IVIG at their institution from 2010 to 2017. During the study period, 151 infectious events occurred during 918 months of IVIG treatment compared with 446 infectious events during 2484 months of observation.
In the overall study population, no difference in the annual rate of infectious events per patient was found between those who received IVIG and those who underwent observation (1.97 vs 2.16; incidence rate ratio [IRR] 0.92; 95% CI, 0.76-1.10; P =.376).
However, differences were observed in 2 subgroups. Patients with hypogammaglobulinemia and those whose MM was in a nonprogressive disease phase had significant reductions in all-grade infectious events (1.20 vs 1.92; IRR, 0.63; 95% CI, 0.45-0.88; P =.009) and grade 3 or worse infectious events (0.25 vs 0.56; IRR, 0.45; 95% CI, 0.22-0.94; P =.041) compared with observation.
The researchers noted that although IVIG was effective, it is not without complications including risk of thrombotic events, volume overload, and renal failure.
“The role for IVIG during times of [progressive disease] was less clear as patients had high rates of infection regardless of IVIG, likely owing to uncontrolled [multiple myeloma] and more intensive treatment strategies at time of progression,” the researchers concluded. “Further studies are needed to confirm these findings and to further refine patient selection for use of IVIG in multiple myeloma.”
Disclosure: Several study authors have declared affiliations with the pharmaceutical industry. Please see the original article for a full list of authors’ affiliations.
Reference
Lancman G, Lozada K, Athar N, et al. Efficacy of intravenous immunoglobulin for preventing infections in patients with multiple myeloma. Clin Lymphoma Myeloma Leuk. Published online February 7, 2021. doi:10.1016/j.clml.2020.12.026