Blood Res.  2022 Jun;57(2):135-143. 10.5045/br.2022.2021163.

Immunoglobulin repletion during blinatumomab therapy does not reduce the rate of secondary hypogammaglobulinemia and associated infectious risk

• Wo S
• Levavi H
• Mascarenhas J
• Kremyanskaya M
• Navada S
• Bar-Natan M
• Kim SS

• KMID: 2530878
• DOI: http://doi.org/10.5045/br.2022.2021163

Abstract

Background
Blinatumomab has demonstrated efficacy in minimal residual disease (MRD) positive and relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) by inciting rapid and sustained B-cell depletion.
Methods
Owing to its effect on B-cells, blinatumomab is associated with a higher rate of secondary hypogammaglobulinemia compared to chemotherapy. To mitigate blinatumomab-induced hypogammaglobulinemia, patients were pre-emptively repleted with intravenous immune globulin (IVIG) during blinatumomab therapy. In this retrospective study, we compared outcomes of 23 blinatumomab treated adults with ALL. Seventeen patients routinely received IVIG and 6 patients were in the control cohort.
Results
Our findings demonstrated no difference between the two cohorts in immunoglobulin G (IgG) nadir (338 mg/dL vs. 337 mg/dL, P =0.641), days to IgG nadir (120.5 vs. 85.5 days, P =0.13), infection rate (82.4% vs. 66.7%, P =0.58), infections requiring ICU admission (23.5% vs. 16.7%, P =1), and infection related mortality (17.6% vs. 16.7%, P =1).
Conclusion
Pre-emptive IVIG repletion during blinatumomab did not prevent hypogammaglobulinemia and associated infection risk.

Keyword

Acute lymphoblastic leukemia; Blinatumomab; Hypogammaglobulinemia; ALL; Intravenous immunoglobulin

Figure

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  Fig. 1 Serum IgG levels for patients in the IVIG cohort collected at baseline and to end of follow-up. Abbreviation: HGG, hypogamma-globulinemia.

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  Fig. 2 Serum IgG levels for patients in the control cohort collected at baseline and to end of follow-up. Abbreviation: HGG, hypogamma-globulinemia.

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