Immunoglobulin repletion during blinatumomab therapy does not reduce the rate of secondary hypogammaglobulinemia and associated infectious risk
Stephanie Wo1, Hannah Levavi2, John Mascarenhas2, Marina Kremyanskaya2, Shyamala Navada2, Michal Bar-Natan2*, Sara S. Kim1*
1Department of Pharmacy, The Mount Sinai Hospital, 2Division of Hematology/Oncology, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
Correspondence to: Michael Bar-Natan, M.D.
Division of Hematology/Oncology, Icahn School of Medicine at The Mount Sinai Hospital, One Gustave L. Levy Place, Box 1079, New York, NY 10029-6574, USA
E-mail: Michal.Bar-Natan@mssm.edu

*These authors contributed equally to this work.
Published online: May 13, 2022.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Blinatumomab has demonstrated efficacy in minimal residual disease (MRD) positive and relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) by inciting rapid and sustained B-cell depletion.
Methods: Owing to its effect on B-cells, blinatumomab is associated with a higher rate of secondary hypogammaglobulinemia compared to chemotherapy. To mitigate blinatumomab-induced hypogammaglobulinemia, patients were pre-emptively repleted with intravenous immune globulin (IVIG) during blinatumomab therapy. In this retrospective study, we compared outcomes of 23 blinatumomab treated adults with ALL. Seventeen patients routinely received IVIG and 6 patients were in the control cohort.
Results: Our findings demonstrated no difference between the two cohorts in immunoglobulin G (IgG) nadir (338 mg/dL vs. 337 mg/dL, P=0.641), days to IgG nadir (120.5 vs. 85.5 days, P=0.13), infection rate (82.4% vs. 66.7%, P=0.58), infections requiring ICU admission (23.5% vs. 16.7%, P=1), and infection related mortality (17.6% vs. 16.7%, P=1).
Conclusion: Pre-emptive IVIG repletion during blinatumomab did not prevent hypogammaglobulinemia and associated infection risk.
Keywords: Acute lymphoblastic leukemia, Blinatumomab, Hypogammaglobulinemia, ALL, Intravenous Immunoglobulin


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