PMID- 29702054
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20190228
IS  - 1552-5775 (Electronic)
IS  - 1552-5767 (Print)
IS  - 1552-5767 (Linking)
VI  - 22
DP  - 2018
TI  - Prevalence and Safety of Intravenous Immunoglobulin Administration During 
      Maintenance Chemotherapy in Children with Acute Lymphoblastic Leukemia in First 
      Complete Remission: A Health Maintenance Organization Perspective.
PG  - 17-141
LID - 10.7812/TPP/17-141 [doi]
LID - 17-141
AB  - CONTEXT: Children with acute lymphoblastic leukemia (ALL) in first complete 
      remission (CR1) experience hypogammaglobulinemia and are at risk of sepsis during 
      maintenance chemotherapy. Intravenous immunoglobulin (IVIG) has been used to try 
      to circumvent this risk, but no data exist regarding its safety and prevalence in 
      a health maintenance organization. OBJECTIVE: To evaluate the prevalence and 
      safety of IVIG in children with ALL in CR1 during maintenance chemotherapy. 
      DESIGN: A multicenter, retrospective cohort study of consecutive children with 
      ALL in CR1 during maintenance chemotherapy from 2008 to 2014. Groups treated with 
      or without IVIG were compared using nonparametric statistics. Multivariate 
      logistic regression involved all variables available before maintenance therapy 
      began. RESULTS: One hundred eighteen patients were included (53% males), aged 9 
      months to 19 years. Thirty of 31 patients (97%) who had immunoglobulins analyzed 
      before IVIG were hypogammaglobulinemic. Thirty-six patients (30%) received IVIG 
      during maintenance chemotherapy. Patients received an average of 10.5 IVIG doses 
      (range = 1-31). Ninety-seven percent of doses were administered without a 
      transfusion reaction. Other factors associated with IVIG use were prior 
      double-delayed intensification (odds ratio = 5.36, 95% confidence interval = 
      1.3-27.49, p = 0.026) and episodes of bacteremia or fungemia before maintenance 
      chemotherapy (odds ratio = 3.04, 95% confidence interval = 1.25-7.51, p = 0.015). 
      CONCLUSION: Use of IVIG in children with ALL in CR1 with hypogammaglobulinemia 
      occurred in approximately 30% of patients and was well tolerated. Administration 
      of IVIG significantly correlated with a history of double-delayed intensification 
      and prior bacteremia or fungemia.
FAU - Van Winkle, Patrick
AU  - Van Winkle P
AD  - Pediatric Hospitalist at the Anaheim Medical Center in CA. 
      patrick.j.vanwinkle@kp.org.
FAU - Burchette, Raoul
AU  - Burchette R
AD  - Statistician for Kaiser Permanente Southern California Research and Evaluation in 
      Pasadena. raoul.j.burchette@kp.org.
FAU - Kim, Raymond
AU  - Kim R
AD  - Research Assistant for Kaiser Permanente Southern California Research and 
      Evaluation in Pasadena. rwhkim@gmail.com.
FAU - Raghunathan, Rukmani
AU  - Raghunathan R
AD  - Pediatric Oncologist in the Department of Pediatric Hematology and Oncology at 
      the Anaheim Medical Center in CA. rukmani.raghunathan@kp.org.
FAU - Qureshi, Naveen
AU  - Qureshi N
AD  - Pediatric Oncologist in the Department of Pediatric Hematology and Oncology at 
      the Anaheim Medical Center in CA. naveen.a.qureshi@kp.org.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Perm J
JT  - The Permanente journal
JID - 9800474
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adolescent
MH  - Agammaglobulinemia/*complications/*drug therapy
MH  - Bacteremia/complications
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Fungemia/complications
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage/*therapeutic use
MH  - Infant
MH  - Maintenance Chemotherapy/methods
MH  - Male
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*complications
MH  - Prevalence
MH  - Remission Induction
MH  - Retrospective Studies
MH  - Young Adult
PMC - PMC5922965
COIS- Disclosure Statement The author(s) have no conflicts of interest to disclose.
EDAT- 2018/04/28 06:00
MHDA- 2018/12/12 06:00
PMCR- 2018/01/01
CRDT- 2018/04/28 06:00
PHST- 2018/04/28 06:00 [entrez]
PHST- 2018/04/28 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2018/01/01 00:00 [pmc-release]
AID - 17-141 [pii]
AID - 10.7812/TPP/17-141 [doi]
PST - ppublish
SO  - Perm J. 2018;22:17-141. doi: 10.7812/TPP/17-141.