Immunoglobulin elevation therapy not associated with a reduced risk of serious infections in patients with LLC

In patients with chronic lymphocytic leukemia (LLC). In addition, regular treatment with immunoglobulin replacement therapy was not associated with a reduced risk of serious infections requiring hospitalization, according to a study published in Blood advances. However,

This is the first major study of the real world to follow patients with LLC who regularly. Consequently, receive the replacement of immunoglobulins. Furthermore, Given its high cost and variable use in clinical practice, this is a critical question of policy, economic and clinical. However, “”

Sara Carrillo de Albornoz, main study author, health economist and doctoral student at Monash University, Australia

RLL, a common type of leukemia in adults, disrupts the production of antibodies (immunoglobulin molecules by the body) which fight against infections. Furthermore, As a result, immunoglobulin elevation therapy not associated LLC patients are often sensitive to serious and potentially fatal infections. Consequently, Treatment with immunoglobulin replacement therapy is often used to increase antibody levels in order to reduce the risk of infection.

“Many studies supporting the use of immunoglobulins to reduce infections in patients with blood cancer dates back over thirty years. Therefore, and the treatment of the LLC has increased considerably since then,” said the author of the study Erica Wood, AO, MD, professor at Monash University. Similarly, “Although immunoglobulins are likely to benefit certain patients. there is still a critical need to better understand the extent of this advantage, which is most likely to benefit and how long these patients should receive treatment. »»

The research team used related data from the Victorian cancer register. the death of death and all admitted episodes, which included longitudinal data in hospital and death for patients aged 18 and over which immunoglobulin elevation therapy not associated had been diagnosed with the LLC between January 1, 2008 and December 31, 2022 in Victoria, Australia. The total study cohort was 6,217 patients, with 5,464 (87.9%) who did not receive immunoglobulin replacement therapy and 753 (12.1%) having received at least one dose during their follow -up period, which was on average 6.9 years.

During the entire 14 -year follow -up period. in patients who have remained alive, the proportion of those who receive therapy for replacement from immunoglobulin rose from 2% in the first year after diagnosis at 8.8% in 14 years. Meanwhile, 2,191 of the 6,217 (35.2%) patients died, with a median diagnostic time of around ten years. Among the full cohort of the study. patients who had a serious infection were much more likely to start receiving immunoglobulin replacement therapy within 30 days of their infection, at a rate of 0.075 per person-home (a unit measuring the immunoglobulin elevation therapy not associated incidence for each person observed for a month), against only 0.001 per person-house for those who without serious infection. Of the 753 patients who started replacement therapy for immunoglobulin, 346 (45.9%) died during follow -up, with median survival of approximately six years after the first treatment. In accordance with the overall cohort of the study. beneficiaries of the replacement therapy of immunoglobulins who had been hospitalized for serious infection in the last month have shown a higher 30-day mortality rate by those without infections (0.090 against 0.008, respectively)-highlighting the significant impact of infections as patients with CLL.

Despite the growing use of immunoglobulin replacement therapy during the study period. the rate of serious infections requiring hospitalization increased from 1.9% to 3.9%. Researchers also noted that among patients regularly receiving immunoglobulins. there was a significantly higher impact of infection while on the replacement treatment of immunoglobulins compared to the periods of immunoglobulin elevation therapy not associated treatment outside treatment (0.056 against 0.038 infections per person-house, respectively). Among regular immunoglobulin patients, 46.9% remained under treatment from one to five years and 23.5% received immunoglobulins for more than five years, conditional to monitoring and survival.

“We have not only seen a reduction in infection rates. hospitalizations in patients receiving immunoglobulins, we found that many were on this therapy for long periods,” said Dr. Wood. “It is essential that we evaluate how long these patients remain under treatment. why avoid unnecessary, prolonged and costly therapy of a product in limited food. »»

Immunoglobulins are generally administered intravenously in a hospital, although subcutaneous perfusions at home increase in popularity. The high cost of therapy is largely motivated by its complex manufacturing process. aggravated by the frequency of treatment; For patients with LLC, intravenous immunoglobulins are generally administered on a monthly basis. In Australia. where this study took place, the cost immunoglobulin elevation therapy not associated of immunoglobulin is entirely subsidized by the government, but in the United States and in other countries, the financial burden may be significant.

“The cost of this therapy. its charge for patients and the models of use and infection that we have observed are a clear call for better directives on the use of immunoglobulins,” said Carrillo. “Although there are criteria for accessing therapy funded by the government in this population in Australia. clear clinical directives are lacking. »»

The study has certain limits given its retrospective nature. namely potential selection biases and incomplete data, in particular around clinical prognostic factors, the severity of the disease and the treatment of cancer. In addition. there were significant differences at the start between compared groups of patients, in particular those who did and did not receive immunoglobulins and those who received it regularly compared to the intermittent.

Researchers currently have current monitoring immunoglobulin elevation therapy not associated studies. including a clinical trial comparing immunoglobulins and antibiotics for prevention of infections in patients with LLC, non -hodgkin and multiple myeloma, and studies on the cost of immunoglobulins and serious infections for patients with blood cancer.