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. 2022 Jun 30;57(2):135-143.
doi: 10.5045/br.2022.2021163. Epub 2022 May 13.

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

Stephanie Wo  1 , Hannah Levavi  2 , John Mascarenhas  2 , Marina Kremyanskaya  2 , Shyamala Navada  2 , Michal Bar-Natan  2 , Sara S Kim  1
Affiliations

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

Stephanie Wo et al. Blood Res. .

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.

Keywords: ALL; Acute lymphoblastic leukemia; Blinatumomab; Hypogammaglobulinemia; Intravenous Immunoglobulin.

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Conflict of interest statement

Authors’ Disclosures of Potential Conflicts of Interest

No potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Serum IgG levels for patients in the IVIG cohort collected at baseline and to end of follow-up. Abbreviation: HGG, hypogamma-globulinemia.
Fig. 2
Fig. 2
Serum IgG levels for patients in the control cohort collected at baseline and to end of follow-up. Abbreviation: HGG, hypogamma-globulinemia.
See this image and copyright information in PMC

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