Intravenous immune globulin (IVIG) replacement therapy is a supportive measure that some doctors prescribe to B-cell chronic lymphocytic leukemia (CLL) patients when they have hypogammaglobulinemia (low serum levels of all antibodies, such as IgG, IgM, and IgA) or are at a high risk of frequent recurrent infections.
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B-cell chronic lymphocytic leukemia (CLL) is a type of blood cancer that affects B lymphocytes, the type of white blood cells (WBCs) that produce antibodies to fight infections.
However, patients with B-cell CLL do not produce functional antibodies, which weakens their immune systems and makes them highly susceptible to viral or bacterial infections.
This article briefly discusses B-cell chronic lymphocytic leukemia, how IVIG can help patients with it, and what IVIG brands are available for B-cell CLL conditions.
What Is B-Cell Chronic Lymphocytic Leukemia (CLL)?
B-cell chronic lymphocytic leukemia (CLL) is one of the most common types of blood cancer, which arises when cancerous B cells proliferate at an unexpected rate and increase in number over time.
Normally, in healthy individuals, lymphoid stem cells differentiate into active mature B lymphocytes that strengthen the immune system and fight infections. However, in individuals with B-cell CLL, mutated lymphoid stem cells differentiate into abnormal B cells, which further divide and start to accumulate in the bone marrow, blood, lymph nodes, spleen, and liver.
These abnormal B lymphocytes look like mature B cells but are functionally incompetent and less effective at fighting infections due to impaired antibody production.
Furthermore, unlike normal cells, abnormal B lymphocytes do not undergo apoptosis (a natural cell death process). Because of this, an excessive number of abnormal B cells occupy space in the bone marrow and interfere with the production of healthy blood cells, such as red blood cells (RBCs), platelets, and WBCs.
Role of IVIG in B-Cell Chronic Lymphocytic Leukemia (CLL)
Patients with B-cell chronic lymphocytic leukemia (CLL) do not produce enough functional antibodies (such as IgG) and experience secondary hypogammaglobulinemia. This makes them more prone to repeated sinus or lung infections.
IVIG replacement therapy can help reduce the number of recurrent infections in B-cell CLL patients. For example, a meta-analysis of nine trials showed that IVIG replacement therapy significantly reduces major infections in CLL patients.
How Does IVIG Work?
Although the exact mode of action of IVIG therapy is unknown, studies show that it exerts anti-inflammatory effects and boosts the immune system. In B-cell CLL patients, IVIG can exert the following beneficial effects:
- It Increases Serum Immunoglobulin Levels
IVIG therapy increases the level of immunoglobulin in B-cell CLL patients with secondary hypogammaglobulinemia. This not only helps the patients fight infection but also reduces the frequency and severity of the infections in B-cell CLL patients.
- It Exerts Anti-Inflammatory Effects
Besides reducing infection frequency, IVIG also reduces the inflammation associated with B-cell chronic lymphocytic leukemia.
- It Reduces the Risks of Autoimmune Complications
Autoimmune complications are also common in B-cell CLL patients. In some patients, it has been observed that abnormal B cells also produce cytokines that inhibit the normal production process of red blood cells (RBCs) and platelets, which results in the development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP).
IVIG therapy can help to reduce the risks of hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) in B-cell CLL patients.
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Is There Any Specific Brand of IVIG Available for B-Cell Chronic Lymphocytic Leukemia (CLL) Patients?
Yes, the following are some specific IVIG brands that are used to treat B-cell Chronic Lymphocytic Leukemia:
These IVIG drugs can be used alone or in combination with chemotherapy to treat B-cell Chronic Lymphocytic Leukemia. Moreover, the dosage and concentration of each IVIG brand differs. You can consult your healthcare provider and get a prescription based on your condition.
Do All B-Cell Chronic Lymphocytic Leukemia (CLL) Patients Require IVIG Therapy?
No, not all B-cell Chronic Lymphocytic Leukemia patients require IVIG replacement therapy. It is only given if a patient has a low serum immunoglobulin level (IgG < 600 mg/dl) or a history of at least one episode of severe infection in 6 months.
Summary
IVIG is an effective therapy that can help in managing several complications associated with B-cell chronic lymphocytic leukemia. It boosts the serum antibody level and reduces the risks of recurrent infections and autoimmune conditions like hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) in B-cell chronic lymphocytic leukemia patients.
REFERENCES:
- Tsang, M., & Parikh, S. A. (2017). A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia. Current Hematologic Malignancy Reports, 12(1), 29. https://doi.org/10.1007/s11899-017-0366-1
- Colado, A., Elías, E. E., Sarapura Martínez, V. J., Cordini, G., Morande, P., Bezares, F., Giordano, M., Gamberale, R., & Borge, M. (2021). Immunomodulatory effects of different intravenous immunoglobulin preparations in chronic lymphocytic leukemia. Scientific Reports, 11. https://doi.org/10.1038/s41598-021-92412-8
- Khan, S., Allsup, D., & Molica, S. (2023). An updated perspective on immunoglobulin replacement in chronic lymphocytic leukaemia in the era of targeted therapies. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1135812
- Gamm, H., Huber, C., Chapel, H., Lee, M., Ries, F., & Dicato, M. A. (1994). Intravenous immune globulin in chronic lymphocytic leukaemia. Clinical and Experimental Immunology, 97(Suppl 1), 17-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550375/
- Gamm, H., Huber, C., Chapel, H., Lee, M., Ries, F., & Dicato, M. A. (1994). Intravenous immune globulin in chronic lymphocytic leukaemia. Clinical and Experimental Immunology, 97(Suppl 1), 17-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550375/
- Dicato, M., Chapel, H., Gamm, H., Lee, M., Ries, F., Marichal, S., Wirth, C., Griffith, H., & Brennan, V. (1991). Use of intravenous immunoglobulin in chronic lymphocytic leukemia. A brief review. Cancer, 68(S6), 1437-1439. https://doi.org/10.1002/1097-0142(19910915)68:6+<1437::AID-CNCR2820681406>3.0.CO;2-H
- Chapel, H. (1992). IVIG indications in patients with chronic lymphocytic leukaemia. Transfusion Science, 13(3), 301-308. https://doi.org/10.1016/0955-3886(92)90140-C
