My husband - CLL, on Calquence since April 2021 - has begun a schedule of monthly IVIG, mainly because he had 2 life threatening infections late spring/early summer (staph that went rogue, followed by c. Diff thanks to months of antibiotics). His ID doc has said that the IG may likely have Covid antibodies in it.
For those who get IV(or subcutaneous) IG, I’m wondering how soon this has an effect on the immune system. I think what we were initially told is that IVIG is basically like pouring immunity into the body, but not sure if that’s overstating it a bit.
While we’re certainly not planning to throw caution to the wind, we haven’t really let down our guard at all - still not eating indoors, going inside friends’ homes/letting others inside our home, doing anything inside at all. With COVID back on the rise we’ve not really changed our behavior…but wondering if others experienced a higher level of wellness/immunity/protection since a regular schedule of IG. At the very least, I’m hoping that IVIG is cause for easing bit of stress and worry around potential for infections, as well as potential for infections to become problematic and dangerous.
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OaktownA
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While having the antibodies infused confers a certain amount of immediate immunity, there's some evidence that other parts of the immune system are stimulated after infusion, which would provide extra benefit. It's hard to say how long it might take for extra immunity to reach a peak, since it involves making new cells. Our disease as well as nutrition will determine how much extra benefit (are our T cells working or exhausted? Are we absorbing enough nutrition to make extra cells?) one may get, I would think.
"....recent studies have broadened the possible uses of polyclonal immunoglobulin showing that it can stimulate certain sub-populations of T cells with effects on T cell proliferation, survival and function in situations of lymphopenia."
I started on IVIG during my hospital stay for a life threatening bacterial infection. Almost dying is the threshold in Ontario for continuing regular immunoglobulin infusions. That was 3.5 years ago. During COVID, my monthly IVIG was converted to at home weekly SCIG. Basically the same as IVIG, the immunoglobulin is infused by yourself under the skin on your tummy as opposed to intravenously and done weekly (quarter of the dosage)
The impact of IVIG is almost immediate and “pouring immunity into your body” is a good description. Your IGG should move into the normal range very soon after your first infusion and stay there. My cll specialist prefers the weekly SCIG since your immunity becomes constant as opposed to IVIG where there are immunity peaks and valleys because the infusion is only once per month.
In the 3.5 years since, I haven’t had a serious infection other than a bout of COVID earlier this year. I managed to get through COVID in a couple of days whereas my wife, healthy as a horse, suffered for a month. My cll specialist believes that my “favourable” experience with COVID was due in large part to the increased immunity gained from regular infusions of immunoglobulin.
So, you’re right in believing that IVIG will take away some of the stress and worry about infections. You still have to practice caution and hygiene but IVIG will likely provide an additional level of protection.
I liken an IgG infusion to a transplant of the shared immunity protection from at least 1,000 blood and plasma donors from whom a batch of IgG is made. You immediately gain protection from all the infections, vaccinations and boosters they've had. healthunlocked.com/cllsuppo... The problem is that the IgG has a half life of about 3 weeks, so after the initial boost, half of that shared immunity is gradually lost. My specialist arranged blood tests prior to each of my infusions, so I was able to compare my estimated results to actual measurements and calculate my own IgG half life and it was within a couple of days of the expected result. It took 3 months to boost my average IgG serum level to a new stable result of around 8 to 14 grams per litre. (I worked out how much immunity I was gaining from calculating my increase in blood serum concentration. Adults have a blood volume of around 5 litres and since you know how many grams of IgG are infused, it's a fairly easy calculation. Then it was just a matter of adjusting the half life until my blood test results best matched my calculated IgG.)
As Vizilo notes, subcutaneous IgG has the advantage of smoothing out the peaks and providing you with a more constant level of immunity. The IgG is infused into a pocket under your abdominal or thigh skin, from where it gradually diffuses into your blood over the coming week.
SofiaDeo has provided a link to a very informative paper, with section 3 answering your question very well.
With my emphasis:
3. Pharmacokinetics of IVIg
Human normal immunoglobulin is immediately and completely bioavailable in the recipient’s circulation after intravenous administration. It is distributed relatively rapidly between plasma and extravascular fluid, after approximately 3–5 days equilibrium is reached between the intra and extravascular compartments.
The half-lives of most IgG antibodies are considerably longer, 6–8 days in mice [54] and 7–21 days in healthy humans [55] and 33–36 days in immunodeficient patients receiving IVIg infusions [56]. This increases the availability of sufficient specific IgG to fight infection.
After administration of relatively large amounts of IVIg (0.1–2 g/kg body mass), the IgG concentration in serum immediately rises, falls rapidly in the first 1 to 7 days, and then falls more slowly thereafter. The initial rapid fall is associated with passage of IgG out of the vasculature into lymph and extracellular fluid compartments. The subsequent decline is mainly caused by catabolism while IgG in lymph and tissues slowly diffuses back into the circulation [57].
The median serum half-life of IgG is 23 days, which is much longer than for IgM (5.1 days) and IgA (5.6 days) [57].
Also from section 2
Plasma used in the production of IVIg comes from two origins: approximately 20 percent is from blood donors, and the other 80 percent is from plasma donors [12]. Individual plasmas are pooled; the pool size is a minimum of 1000 donors, but may be up to 100,000 donors
This is why I recommend that if anyone asks what they can do to help anyone with CLL, just encourage them to be a blood donor. Not only do donors reduce our risk of potentially fatal infections from their donated IgG, they can also save our lives if we ever need red blood cell or platelet infusions. I'd be interested about what happens in other countries, but in Australia, long weekends tend to be the occasion when there are public service announcements encouraging people to donate blood to help with increased requirements from trauma patients - primarily from vehicle crashes. That's why there's a public perception in Australia that blood donations are primarily used to replace physical trauma related blood loss. It's actually people with cancer that are the primary beneficiaries of those very much appreciated blood donors.
The problem with IVIG giving you immunity against the current strain of Covid, is that it takes at least 6 months for the antibodies taken out of a blood doners arm to be infused in yours. The strain of Covid that was prevalent 6 months ago is not the strain of Covid that is prevalent now, and there wasn't a vaccine against the current strain of Covid 6 months ago. So by the time the public doner blood supply get enough Covid antibodies in it to put them in IVIG it will be probably much longer than 6 months from now and by then there could be yet a newer Covid strain.
As you note, it's taking longer than 6 months for vaccines against the more recent COVID-19 variants to be approved. However, thankfully, for now, vaccines against older variants are still providing reasonable levels of protection against the latest variants.
Also, most of the population now has COVID-19 antibodies due to vaccination and or infection(s), so hopefully IgG infusions might reduce the severity of an infection or at least protect us against opportunistic infections (e.g. pneumonia) when we have COVID-19 or another respiratory infection.
My weekly subcutaneous IgG has improved my daily life in that I no longer get sinus or skin/soft tissue infections, etc. that happened a lot in the past. However, the IVIG an subcutaneous IgG infusions do not have high enough specific antibodies to protect against getting severe disease from COVID-19, RSV, or many other infections. If your spouse is still able to mount antibodies from vaccines, then in addition to his IVIG, he should still get a COVID-19 booster, a flu shot, and an RSV vaccination next month in October. If he does not react to vaccines, and doesn't make antibodies (as shown on quantitative lab testing a few weeks after a vaccination), then masking and waiting for the updated Evusheld is even more important. I still have no B-cells (CD 19 on a lymphocyte panel since O+V treatment), so I do not rely on IVIG or Subcutaneous IgG infusions for protection. But, I am much healthier from the IgG infusions and usually miss no days of outdoor exercise thanks to it.
I started monthly IVIG infusions in March / April this year, but still managed to get two serious chest infections, then Influenza A which has taken quite a while to recover from. I’m extremely cautious, wearing a mask etc. Hopefully, the warmer weather may help. I’ve been sick all winter. Indie. Australia.
My husband receives monthly infusions of IVIG along with his chemo. (Due to a secondary fungal lung infection also diagnosed )
To answer your question YES, it gives them an extra immune boost of cells their body cannot maintain.
It will help avoid a headache if he stays well hydrated following the infusion for about 3 days , in our experience
Now my husband had Covid last year, and we feel the IVIG gave him extra protection, helping him recover. He recovered at home even from pneumonia .
We believe the IVIG gives him a good immunity. Giving it to him on a monthly basis , helps keep his body stronger to fight off exposure to infections.
We eat with family groups for birthdays and holidays. He stays comfortably in a room with people nearby. If anyone has a cough… we avoid them.
He won’t eat out in a restaurant. We haven’t assembled in our small church with the choir or congregation, unfortunately.
*The IVIG was given to him 2 weeks prior to a hip replacement surgery last summer. And the 2 weeks after. ***He will be doing this same process for his opposite hip next month ***
It has definitely improved his quality of life, enabling him to enjoy our family and grandchildren as much as we can.
Wishing you the best results and more good memories made with your loved ones.
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