Relevance and management of secondary hypogammaglobulinema in clinical practice

Abstract

Advance protocols for the treatment most of oncology, hematology and some inherited disorders may lead to development severe secondary hypogammaglobulinaemia. Particularly, it is often caused by therapy with monoclonal antibodies binding B-cells (such as rituximab, belimumab, inotuzumab), therapy with inhibitors of tyrosine-kinase (imatinib, desatinib), as well as applying a variety of immunosuppressive and chemotherapy agents (steroids, azathioprine, cyclophosphamide etc.). It should be note, that chronic lymphoid leukemia and multiple myeloma could be complicated with hypogammaglobulinaemia, not only because of specific therapy, but also as features of the diseases. Hematopoietic stems cells transplantation can also lead to development severe and prolonged hypogammaglobulinaemia. This is associated with intensive immune/myeloablative therapy, as well as with immunologic reconstitution after transplantation. Modern intravenous immunoglobulins (IVIG) have a wide repertoire of pathogen-specific activity with high safety profile and constitute essential part of therapy patients with secondary hypogammaglobulinaemia. The paper presents literature review of IVIG usage in various clinical situations, as well as several clinical examples of personal experience.