ArticleJCO oncology practice2021
Changes in Intravenous Immunoglobulin Usage for Hypogammaglobulinemia After Implementation of a Stewardship Program.
Article in JCO oncology practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- A systematic review of the cost and cost-effectiveness of immunoglobulin treatment in patients with hematological malignancies.International journal of technology assessment in health care · 2024Pooled it
- Chimeric Antigen Receptor T Cell Therapy for Myeloma: Where Are We Now and What Is Needed to Move Chimeric Antigen Receptor T Cells Forward to Earlier Lines of Therapy? Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy.Transplantation and cellular therapy · 2024Guideline
- Controversies about immunoglobulin replacement therapy in HSCT recipients with hypogammaglobulinemia.Bone marrow transplantation · 2022Pooled it
- The Impact of Hospital-Based Fidaxomicin Use Criteria onInfectious disease reports · 2026Article
- Bridging the Gap in Secondary Antibody Deficiencies: Current Evidence and Unmet Needs in Diagnosis and Management with Immunoglobulin Replacement.Clinical reviews in allergy & immunology · 2025Review
- Immunoglobulin prophylaxis should be initiated after bispecific antibody therapy in multiple myeloma, regardless of IgG levels.Blood advances · 2025Review
- [Interpretation of the 2023 International Society for Burn Injuries "Surviving Sepsis After Burn Campaign"].Zhonghua shao shang yu chuang mian xiu fu za zhi · 2025Article
- Use of non-specific immunoglobulins in Catalonia in three third-level hospitals: a descriptive analysis of a hospital-prescribed medication registry.Frontiers in pharmacology · 2024Article
- Using a scenario approach to assess for the current and future demand of immunoglobulins: An interview and literature study from The Netherlands.Transfusion medicine (Oxford, England) · 2022Review
- Ten-year population trends of immunoglobulin use, burden of adult antibody deficiency and feasibility of subcutaneous immunoglobulin (SCIg) replacement in Hong Kong Chinese.Frontiers in immunology · 2022Observational
- Single-Center Experience of Outcomes and Prescribing Patterns of IV Immunoglobulin Use in Critically Ill Patients.Critical care explorations · 2021Article
- Access and use of immunoglobulins in supportive cancer care: A thematic analysis of a systematic review data set.The journal of medicine accessArticle
- Access and use of immunoglobulins in secondary supportive cancer care: A systematic literature review.The journal of medicine accessReview
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIntravenous immunoglobulin (IVIG) is used to replenish immunoglobulins in hypogammaglobulinemia (HG) caused by hematologic malignancies (HM) or their treatment (autologous stem-cell transplantation [ASCT] and chimeric antigen receptor T-cell therapy [CAR-T]), in an effort to reduce the risk of infections. However, there is limited evidence to support this use, and IVIG supplies are limited and shortages are common.
methodsAn IVIG stewardship program (ISP) was implemented with the following requirements for IVIG administration: immunoglobulin G (IgG) level < 400 mg/dL (corrected for paraprotein) for post-ASCT and post-CAR-T patients, or IgG < 400 mg/dL with a history of a bacterial infection within the preceding 3 months for those with HM. Comparisons of the amount of IVIG administered, the incidence of infections, and the use of antimicrobials were performed between the 3 months before ISP and the 3 months after ISP.
resultsIVIG administered for HG decreased from 4,902 g in 86 patients before ISP to 1,777 g in 55 patients after ISP, a cost savings of $44,700. Adherence to ISP guidelines was 80%. Compared with before ISP, patients who stopped receiving IVIG after ISP had lower nadir IgG, fewer infections/patient-months, less antimicrobial usage, and a lower hospitalization rate for infection; no deaths occurred. Compared with before ISP, patients receiving IVIG after ISP had lower predose IgG and fewer infections/patient-months; the antibiotic usage, hospitalization rate for infection, and deaths from infection remained stable.
conclusionTo our knowledge, this is the first ISP to lead to a dramatic decrease in IVIG usage with high adherence, primarily by selecting out patients at low risk of infection after IVIG discontinuation. Such an ISP is replicable and warrants adoption.
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