Retrospective Analysis of Weekly Intravenous Immunoglobulin Prophylaxis Versus Intravenous Immunoglobulin by IgG Level Monitoring in Hematopoietic Stem Cell Transplant Recipients

Abstract

Patients undergoing allogeneic hematopoietic stem cell transplant (allo HCT) have a higher incidence of infections partly due to secondary hypogammaglobulinemia. We evaluated the role of IVIG in allo HCT patients who received prophylactic IVIG 200 mg/kg once weekly regardless of IgG level (Group 1, n 5 115) compared with patients who received IVIG based on IgG level <400 mg/dL (Group 2, n 5 114). Primary endpoints were the utilization of IVIG, incidence of veno-occlusive disease (VOD), graft-versus-host disease (GVHD), and documented infections within the first 100 days after allo HCT. Patients in both groups were similar except for a higher number of matched unrelated donor (MUD) transplants in Group 2 (62 vs. 41, P 5 0.01). There were no significant differences in the incidence all grades of GVHD (55 vs. 50), VOD (2 vs. 0) or infections in the two groups except for a higher incidence of para-influenza infections in group 1 (9 vs. 0, P 5 0.003) coinciding with the flu season. We recommend monthly monitoring of IgG level and replacement only if IgG level is <400 mg/dL. Am. J. Hematol. 87:172–174, 2012. VC 2011 Wiley Periodicals, Inc.