AL-04. Risk-adapted immunoglobulin replacement therapy in patients with acute leukemia: clinical evaluation and comparative analysis
Olga V. Gerasimovich1, Igor A. Iskrov2, Irina Yu. Lendina1
1 Minsk Scientific Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus
2 Belorussian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus
Contact: Dr. Olga V. Gerasimovich, phone: +375293758313, e-mail: gerasimovichov@gmail.com
Summary
Patients with hematological malignancies undergoing chemotherapy (CT) have high incidence of infections which profile is affected by various factors including neutropenia. The clinical effect of immunoglobulin replacement therapy (IRT) with respect to the risk of infectious complications in adult hematological patients currently needs to be assessed and revised. The purpose of this prospective study in the framework of real clinical practice was to evaluate the independent effect of replacement therapy with immunoglobulins on the risk of developing infectious complications in hematological patients.
Materials and methods
The prospective study (2021-2022) included 40 adult patients diagnosed with acute leukemia who received induction and consolidation stages of therapy. Intervention groups (substitution therapy) and the control group were associated with clinical and demographic indicators. For the primary outcome in the analysis, the duration of the period free from infectious episodes in the survival analysis was adopted.
Results
The probability of developing an infectious episode in patients with acute leukemia receiving specific treatment (induction course of polychemotherapy) is statistically significantly lower in the group of patients receiving immunoglobulin replacement therapy compared to the control group without administration of human immunoglobulin (5 versus 14; p=0.00724) as seen on Fig. 1. The median duration of the period without infectious complications in the group of patients who received immunoglobulins against the background of specific therapy for the underlying disease was 105 days (95% CI 88-120 days), while in the control group it was 75 days (95% CI 59-109 days). Fixed effects analysis showed an estimated odds ratio of 2.42 (95% CI 1.86-3.16) as shown on Fig. 2. Random effects analysis, performed by estimating a mean odds ratio of 2.58 (95% CI 1.67-3.99), means that patients treated with IRT have a better chance of a favorable outcome compared to treatment without IRT by 2.58 times.
Conclusion
Immunoglobulin replacement therapy may be used in patients at high risk of infectious complications, given the levels of hypogammaglobulinemia, as well as clinical dynamics. The clinical effect can be assessed within 3 months from the start of replacement therapy.
Keywords
Infections, hematological disorders, immunoglobulins, replacement therapy, acute leukemia, post cytostatic cytopenia.
