Immunoglobulin replacement therapy is required for some patients with lymphoma or chronic lymphocytic leukaemia.
What is immunoglobulin replacement therapy?
Immunoglobulins are proteins (antibodies) found in our plasma. They perform a critical role within the immune response in the body. Antibodies recognise and bind to antigens (such as bacteria or viruses) and assist in their destruction.
Some patients who have lymphoma or chronic lymphocytic leukaemia (CLL) have low immunoglobulin levels in their blood. This is due to advanced disease in some subtypes or from multiple cancer treatment for their lymphoma.
These patients may need immunoglobulin therapy to help replace or restore immunoglobulin levels to help them to fight infections, as they are not able to naturally produce their own. Intravenous immunoglobulins (IVIg) therapy gives antibodies that your body is not making on its own so you can fight infections.
How is IVIg made?
IVIg therapy are fractionated blood products made from human plasma. IVIg is prepared from large pools of human plasma collected from several thousand healthy blood donors and contains the typical IgG antibodies found in the normal population.
Rigorous measures are in place to make sure the therapy is as safe as possible. The donors are carefully screened, and the donations are checked, filtered, and treated to make sure they do not carry infections. The plasma is checked for HIV, Hepatitis B, Hepatitis C and HTLV 1 and 11.
They also undergo at least two processes that destroy viruses.
IVIG products currently used in Australia
- Intragam® 10 is an Australian manufactured IVIg product. Donations all come Australian donations
- Privigen® is an imported IVIg product.
- Flebogamma® is an imported IVIg product.
- Gamunex® is an imported IVIg product.
Indications for IVIg in the haematology setting
- Patients with chronic lymphocytic leukaemia (CLL) whose levels are low and are suffering from frequent infections
- Patients with lymphoma whose levels are low and are suffering from frequent infections
- After an allogeneic stem cell transplant where you have donor stem cells (from someone else).
How is IVIg administered?
- IVIG therapy is often given once a month at first but may be needed less often based on antibody levels.
- Usually done in the outpatient setting.
- Usually given as an intravenous infusion (by a drip into a vein). This is called ‘intravenous immunoglobulin therapy’ (IVIG).
- The length of time the infusion depends on how much immunoglobulin you need.
- It usually takes a few hours to have the infusion.
- The first treatment is given slowly to reduce the risk of side effects.
Some patients have immunoglobulin replacement therapy as an injection under the skin. This is called ‘subcutaneous immunoglobulin therapy’ (SCIG).
To find out more information about s/c immunoglobulin therapy see Lifeblood. Speak to your doctor for more information.
Side effects are usually mild and temporary. The risk of side effects varies depending on individual circumstances, how much immunoglobulin is given and by what method the immunoglobulins are given.
The most common possible side effects are:
- Fatigue (extreme tiredness)
- Pain and swelling at the site (area) of the injection.
- Back pain
- Joint pain
- Stomach pain, nausea, and diarrhoea
- Increased blood pressure
- Stuffy nose or sinus pain
- Skin rash
Side effects can happen with any immunoglobulin treatment, but they are most common with the first treatment. Patients are monitored carefully while the treatment is being given.
Patients who are feeling unwell during or shortly after having immunoglobulin replacement therapy, should tell the nurses straightaway. They can slow down or stop the infusion or give treatments such as paracetamol and antihistamines.
Side effects are less common with subcutaneous immunoglobulin treatments as lower amounts of immunoglobulin are given.