Can IV Immunoglobin Prevent Infection in MM Treatment?

A study published in Clinical Lymphoma, Myeloma, & Leukemia evaluated the efficacy of intravenous immunoglobin (IVIG) to prevent infections in patients being treated for multiple myeloma (MM).

Researchers from the Mount Sinai Health System retrospectively reviewed 68 patients with MM who received IVIG between 2000 and 2017. The primary endpoint was incidence of infections per patient-year during IVIG versus during observation.

During the cumulative total of 918 months of IVIG treatment, 151 infection events (IEs) occurred. Over the 2,484 cumulative months of observation, 446 IEs occurred overall. Annual rates of IEs were substantially higher during periods of progressive disease compared to times of remission, or 4.9 IEs versus 1.8 IEs per patient (P<0.001). However, 75% of IEs occurred during periods of non-progressive disease.

Overall, the investigators found no significant difference in the annual rate of IEs per patient between time of IVIG versus observation (1.97 versus 2.16; incidence rate ratio [IRR] 0.92; 95% confidence interval [CI] 0.76-1.10; P=0.376). The use of IVIG was associated with a significant reduction in all-grade IEs among a subgroup of patients with MM with hypogammaglobulinemia without progressive disease. The annual rate of IEs for this group was 1.20 IEs per patient, compared to 1.92 IEs in patients under observation (IRR 0.63; 95% CI 0.45-0.88; P=0.009).

“The role for IVIG during times of [progressive disease] was less clear as patients had high rates of infection regardless of IVIG, likely owing to uncontrolled [MM] and more intensive treatment strategies at time of progression,” wrote the authors in conclusion. “Further studies are needed to confirm these findings and to further refine patient selection for use of IVIG in MM.”