Please excuse me, but I believe that this study will be "lost" if I cite it in connection with the other topic I posted today. Therefore, I am posting it as a new topic.
The study concerns important data and affects at least 1/3 of all patients with CLL.
Quotes:
Methods:
This was a retrospective sample analysis representative of practices and hospitals in Germany. The treatments and infection data were collected from patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). GL adherence (GLAD) was analyzed.
Conclusions:
Guideline adherence correlated with fewer and less severe infections but was low in patients with indication for IgRT. Risk factors for infection can be identified. Risk of severe infections was significantly lower in patients with IgRT.
This study investigated the quality of guideline adherence (GLAD) in existing indications for IgG substitution in patients with CLL and MM in Germany.
In the present multivariable analysis, patients on BTK inhibitor therapy had a significantly increased risk of infection. In contrast to other studies [32], no increased risk for CLL patients treated with CD20 antibodies such as rituximab and subsequent hypogammaglobulinemia could be measured in this study. However, this may also be due to the fact that about just under two-thirds of the patients not currently treated with CD20 antibodies had already received CD20 antibodies in a previous therapy. It should also be considered that B-cell depletion persists long after the end of treatment, especially in combination with fludarabine [33, 34]. One study showed that IgRT significantly reduced the risk of infection in patients with hypogammaglobulinemia [35].
'Immunoglobulin Replacement Therapy in Chronic Lymphocytic Leukemia patients with hypogammaglobulinaemia and infection; analysis of total national utilization data in Australia 2008-2013
I haven't seen this very interesting study before, which on a quick scan, appears fairly thorough. Given that in Australia we have a single supplier of IgG (which, of note is a privatised government business - I wish I'd bought shares), doing this type of study is significantly easier than in other countries.
Of particular note with regard to blood donations from which the IgG is derived; "This arrangement has been insufficient to collect adequate plasma for fractionation to meet increasing clinical demand for IVIg for more than three decades." Australia imports about 50% of its IgG requirements. Australians voluntarily donate their blood. They aren't given any compensation. I've seen changes in my career where employers used to allow time off for blood donations, but ceased that allowance.
Hello Yalokin, Health Unlocked send me a message that I as someone who has been treated with Rituximab and later Ibrutinib, and who developed hypogammaglobulemia and am treated with IVIg, might be able to say something of interest to you. I am not sure that I can say anything you don't already know, but I am more than happy to share my story.
I was diagnosed in January 2014 with SLL, which later changed into CLL. I was told to live my life 'normally' during the watch and wait period, which probably was not such good advice since 'normal' for me meant lots of travel to exotic places. The result was that I had several infections ( flu, bronchitis and pneumonia ) and a severe case of an allergic reaction which was something I had not experienced before . I also had an increasing allergic response to mosquito bites, which became a determining limitation in my life. All of this was of course due to a malfunctioning immune system but I don't know the details of that.
Then from October 2017 I had a 6-month long chemotherapy and immunotherapy treatment - BR or Bendamustine and Rituximab. It weakened me but I don't remember the period after this period as particularly alarming in terms of infections. The insect bite allergy continued but there were no major events health wise for 2 years. But then in August 2020 I started treatment with Ibrutinib, and suddenly I was having infections all the time. My eyes, my fingers, my mouth and a whole series of colds and stomach bugs.. But then in January 2021 I had what I first thought must be Covid , even though I was shielding and not seeing anyone besides my husband. But the test came back negative, and after that I considered it as 'a flu out of hell'. It felt very violent and even though I did not need to be hospitalised I was frightened by it, and mentioned this to my haematologist when I saw him for a routine visit just after this 'flu' had subsided. It is on the basis of that 'flu' coupled with the many smaller infections, that he prescribed IVIg. We knew already long before this that my gamma globulin G level was low - 4.03 g/L and he had mentioned before that maybe I needed supplementation. This 'flu' was what pushed him to make the prescription and I have been having IVIg ever since, going once a month for an infusion. However there is a twist to the story. The very next day after seeing my haematologist I had another covid test and to my utter surprise it turned out positive! I was told that it was at the end of the covid cycle and when I mentioned that I had been very ill earlier in the month they confirmed that that would have been it and that it had been a false negative. So in fact , my faulty immune system had managed to fight off a covid infection! This was the time before vaccinations were available.
Since I have the IVIg treatment I no longer have the many smaller infections or colds or flu etc, which has been a blessing.. I travelled to the UK this last June and managed to pick up a Salmonella infection, which was very unpleasant but did not become serious and which ended by itself after two weeks. And I did have a gall bladder infection last year and had to have my gall bladder removed, but I had been living for a long time with a gall stone. The main way that I notice now that my immune system is not optimal is through the frequent emergence of pre-cancerous spots and twice the occurrence of basal cell carcinoma which needed to be surgically removed
All in all I am very happy that it has been possible for me to have IVIg so easily here in France, and do feel much more protected than before.
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RICHTER'S TRANSFORMATION IN PATIENTS WITH CLL: ANALYSIS OF BIOLOGICAL AND CLINICAL RISK FACTORS AND OUTCOMES
Important SARS-CoV-2 and Covid-19 information for Chronic Lymphocytic Leukaemia/CLL patients
