PMID- 32822257
OWN - NLM
STAT- MEDLINE
DCOM- 20210712
LR  - 20220302
IS  - 2688-1535 (Electronic)
IS  - 2688-1527 (Print)
IS  - 2688-1527 (Linking)
VI  - 17
IP  - 3
DP  - 2021 Mar
TI  - Changes in Intravenous Immunoglobulin Usage for Hypogammaglobulinemia After 
      Implementation of a Stewardship Program.
PG  - e445-e453
LID - 10.1200/OP.20.00312 [doi]
AB  - PURPOSE: Intravenous immunoglobulin (IVIG) is used to replenish immunoglobulins 
      in hypogammaglobulinemia (HG) caused by hematologic malignancies (HM) or their 
      treatment (autologous stem-cell transplantation [ASCT] and chimeric antigen 
      receptor T-cell therapy [CAR-T]), in an effort to reduce the risk of infections. 
      However, there is limited evidence to support this use, and IVIG supplies are 
      limited and shortages are common. METHODS: An IVIG stewardship program (ISP) was 
      implemented with the following requirements for IVIG administration: 
      immunoglobulin G (IgG) level < 400 mg/dL (corrected for paraprotein) for 
      post-ASCT and post-CAR-T patients, or IgG < 400 mg/dL with a history of a 
      bacterial infection within the preceding 3 months for those with HM. Comparisons 
      of the amount of IVIG administered, the incidence of infections, and the use of 
      antimicrobials were performed between the 3 months before ISP and the 3 months 
      after ISP. RESULTS: IVIG administered for HG decreased from 4,902 g in 86 
      patients before ISP to 1,777 g in 55 patients after ISP, a cost savings of 
      $44,700. Adherence to ISP guidelines was 80%. Compared with before ISP, patients 
      who stopped receiving IVIG after ISP had lower nadir IgG, fewer 
      infections/patient-months, less antimicrobial usage, and a lower hospitalization 
      rate for infection; no deaths occurred. Compared with before ISP, patients 
      receiving IVIG after ISP had lower predose IgG and fewer 
      infections/patient-months; the antibiotic usage, hospitalization rate for 
      infection, and deaths from infection remained stable. CONCLUSION: To our 
      knowledge, this is the first ISP to lead to a dramatic decrease in IVIG usage 
      with high adherence, primarily by selecting out patients at low risk of infection 
      after IVIG discontinuation. Such an ISP is replicable and warrants adoption.
FAU - Derman, Benjamin A
AU  - Derman BA
AD  - Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, 
      IL.
FAU - Schlei, Zachary
AU  - Schlei Z
AD  - Department of Pharmacy, University of Chicago Medical Center, Chicago, IL.
FAU - Parsad, Sandeep
AU  - Parsad S
AD  - Department of Pharmacy, University of Chicago Medical Center, Chicago, IL.
FAU - Mullane, Kathleen
AU  - Mullane K
AD  - Section of Infectious Diseases, University of Chicago Medical Center, Chicago, 
      IL.
FAU - Knoebel, Randall W
AU  - Knoebel RW
AD  - Department of Pharmacy, University of Chicago Medical Center, Chicago, IL.
LA  - eng
PT  - Journal Article
DEP - 20200821
PL  - United States
TA  - JCO Oncol Pract
JT  - JCO oncology practice
JID - 101758685
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - *Agammaglobulinemia/drug therapy
MH  - *Bacterial Infections/prevention & control
MH  - *Hematologic Neoplasms
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
PMC - PMC8257910
EDAT- 2020/08/22 06:00
MHDA- 2021/07/13 06:00
PMCR- 2022/03/01
CRDT- 2020/08/22 06:00
PHST- 2020/08/22 06:00 [pubmed]
PHST- 2021/07/13 06:00 [medline]
PHST- 2020/08/22 06:00 [entrez]
PHST- 2022/03/01 00:00 [pmc-release]
AID - OP.20.00312 [pii]
AID - 10.1200/OP.20.00312 [doi]
PST - ppublish
SO  - JCO Oncol Pract. 2021 Mar;17(3):e445-e453. doi: 10.1200/OP.20.00312. Epub 2020 
      Aug 21.