Risk of infection according to the gamma globulin level in the 100 days following allogeneic stem cell transplantations.
Aged
Bacterial Infections
/ diagnosis
Cyclosporine
/ administration & dosage
Female
Graft vs Host Disease
/ immunology
Hematopoietic Stem Cell Transplantation
/ methods
Humans
Immunoglobulins, Intravenous
/ therapeutic use
Immunologic Deficiency Syndromes
/ etiology
Immunosuppressive Agents
/ administration & dosage
Leukemia
/ immunology
Lymphoma
/ immunology
Male
Middle Aged
Mycophenolic Acid
/ administration & dosage
Mycoses
/ diagnosis
Myeloablative Agonists
/ therapeutic use
Myelodysplastic Syndromes
/ immunology
Opportunistic Infections
/ diagnosis
Prognosis
ROC Curve
Transplantation Conditioning
/ methods
Transplantation, Homologous
Virus Activation
/ drug effects
gamma-Globulins
/ metabolism
allografts
gamma-globulins
hematopoietic stem cell transplantation
infections
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
06
07
2021
received:
20
03
2021
accepted:
08
07
2021
pubmed:
11
7
2021
medline:
20
1
2022
entrez:
10
7
2021
Statut:
ppublish
Résumé
Immunoglobulin replacement therapy is recommended in case of severe hypogammaglobulinemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the supposed increased risk of infection in case of hypogammaglobulinemia has not been confirmed in allo-HSCT. In this study, we assessed the relationship between the gamma globulin level and the risk of infection during the 100 days following the allo-HSCT. We gathered the weekly laboratory tests from day 7 to day 100 of 76 allograft patients, giving a total of 1 044 tests. 130 infections were documented clinically, by imaging, or microbiologically. Average gamma globulin levels between D-7 and D100 did not differ between patients with or without infection (642 ± 232 and 671 ± 246 mg/dL, respectively, P = .65). Gamma globulin level <400 mg/dl was not associated with the occurrence of infection between the test studied and the next one (aOR 1.33 [0.84-2.15], P = .24). The gamma globulin level was not predictive of bacterial or fungal infections (AUC 0.54 [95%CI: 0.47-0.61]) nor of viral reactivations (AUC 0.51 [95%CI: 0.43-0.60]). This confirmed that the humoral deficiency is a minor part of the immune deficiency in the 100 days post-transplant. This questions the relevance of the indications of immunoglobulin substitution during this period.
Sections du résumé
BACKGROUND
BACKGROUND
Immunoglobulin replacement therapy is recommended in case of severe hypogammaglobulinemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the supposed increased risk of infection in case of hypogammaglobulinemia has not been confirmed in allo-HSCT. In this study, we assessed the relationship between the gamma globulin level and the risk of infection during the 100 days following the allo-HSCT.
METHODS
METHODS
We gathered the weekly laboratory tests from day 7 to day 100 of 76 allograft patients, giving a total of 1 044 tests. 130 infections were documented clinically, by imaging, or microbiologically.
RESULTS
RESULTS
Average gamma globulin levels between D-7 and D100 did not differ between patients with or without infection (642 ± 232 and 671 ± 246 mg/dL, respectively, P = .65). Gamma globulin level <400 mg/dl was not associated with the occurrence of infection between the test studied and the next one (aOR 1.33 [0.84-2.15], P = .24). The gamma globulin level was not predictive of bacterial or fungal infections (AUC 0.54 [95%CI: 0.47-0.61]) nor of viral reactivations (AUC 0.51 [95%CI: 0.43-0.60]).
CONCLUSIONS
CONCLUSIONS
This confirmed that the humoral deficiency is a minor part of the immune deficiency in the 100 days post-transplant. This questions the relevance of the indications of immunoglobulin substitution during this period.
Substances chimiques
Immunoglobulins, Intravenous
0
Immunosuppressive Agents
0
Myeloablative Agonists
0
gamma-Globulins
0
Cyclosporine
83HN0GTJ6D
Mycophenolic Acid
HU9DX48N0T
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
489-496Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Simpson E, Dazzi F. Bone marrow transplantation 1957-2019. Front Immunol. 2019;10:1246.
Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143-1238.
Kristinsson VH, Kristinsson JR, Jonmundsson GK, Jonsson OG, Thorsson AV, Haraldsson A. Immunoglobulin class and subclass concentrations after treatment of childhood leukemia. Pediatr Hematol Oncol. 2001;18:167-172.
Oshrine BR, Li Y, Teachey DT, Heimall J, Barrett DM, Bunin N. Immunologic recovery in children after alternative donor allogeneic transplantation for hematologic malignancies: comparison of recipients of partially T cell-depleted peripheral blood stem cells and umbilical cord blood. Biol Blood Marrow Transplant. 2013;19:1581-1589.
Sahin U, Toprak SK, Atilla PA, Atilla E, Demirer T. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation. Journal of Infection and Chemotherapy. 2016;22:505-514.
Misch EA, Andes DR. Bacterial Infections in the stem cell transplant recipient and hematologic malignancy patient. Infect Dis Clin North Am. 2019;33:399-445.
Winston DJ, Ho WG, Rasmussen LE, et al. Use of intravenous immune globulin in patients receiving bone marrow transplants. J Clin Immunol. 1982;2:42S-47S.
Sullivan KM, Kopecky KJ, Jocom J, et al. Immunomodulatory and antimicrobial efficacy of intravenous immunoglobulin in bone marrow transplantation. N Engl J Med. 1990;323:705-712.
Feinstein LC, Seidel K, Jocum J, et al. Reduced dose intravenous immunoglobulin does not decrease transplant-related complications in adults given related donor marrow allografts. Biol Blood Marrow Transplant. 1999;5:369-378.
Sumer T, Abumelha A, Al-Mulhim I, Al-Fadil M. Treatment of fever and neutropenia with antibiotics versus antibiotics plus intravenous gammaglobulin in childhood leukemia. Eur J Pediatr. 1989;148:401-402.
Winston D, Antin J, Wolff S, et al. A multicenter, randomized, double-blind comparison of different doses of intravenous immunoglobulin for prevention of graft-versus-host disease and infection after allogeneic bone marrow transplantation. Bone Marrow Transplant. 2001;28:187-196.
Abdel-Mageed A, Graham-Pole J, Mlud R, et al. Comparison of two doses of intravenous immunoglobulin after allogeneic bone marrow transplants. Bone Marrow Transplant. 1999;23:929-932.
Cordonnier C, Chevret S, Legrand M, et al. Should immunoglobulin therapy be used in allogeneic stem-cell transplantation?: a randomized, double-blind, dose effect, placebo-controlled, Multicenter Trial. Ann Intern Med. 2003;139:8.
Raanani P, Gafter-Gvili A, Paul M, Ben-Bassat I, Leibovici L, Shpilberg O. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. Cochrane Database Syst Rev. 2008;4:CD006501.
Ullmann AJ, Schmidt-Hieber M, Bertz H, et al. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol. 2016;95:1435.
Lewalle P, Pochon C, Michallet M, et al. Prophylaxie des infections post-allogreffe: recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bull Cancer. 2019;106:S23.
Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: a review of evidence. J Allergy Clin Immunol. 2017;139:S1.
Na I, Buckland M, Agostini C, et al. Current clinical practice and challenges in the management of secondary immunodeficiency in hematological malignancies. Eur J Haematol. 2019;102:447-456.
Edgar JDM, Richter AG, Huissoon AP, et al. Prescribing immunoglobulin replacement therapy for patients with non-classical and secondary antibody deficiency: an analysis of the practice of clinical immunologists in the UK and republic of Ireland. J Clin Immunol. 2018;38:204-213.
Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106:2912-2919.
Safdar A, Armstrong D. Infections in patients with hematologic neoplasms and hematopoietic stem cell transplantation: neutropenia, humoral, and splenic defects. Clin Infect Dis. 2011;53:798-806.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2011;52:e56-e93.
Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American society of clinical oncology and infectious diseases society of america clinical practice guideline update. J Clin Oncol. 2018;36:1443-1453.
Kochanek M, Schalk E, von Bergwelt-Baildon M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the infectious diseases working party (AGIHO) and intensive care working party (iCHOP) of the German society of hematology and medical oncology (DGHO). Ann Hematol. 2019;98:1051-1069.
Augusto J-F, Garnier A-S, Demiselle J, et al. Hypogammaglobulinemia and risk of severe infection in kidney transplant recipients. Transpl Infect Dis. 2016;18:741-751.
Blot M, Boyer P, Samson M, et al. Should mild hypogammaglobulinemia be managed as severe hypogammaglobulinemia? A study of 389 patients with secondary hypogammaglobulinemia. Eur J Intern Med. 2014;25:837-842.
Barmettler S, Ong M-S, Farmer JR, Choi H, Walter J. Association of immunoglobulin levels, infectious risk, and mortality with rituximab and hypogammaglobulinemia. JAMA Netw Open. 2018;1:e184169.