Discussion
IVIG products appear with a wide range of indications in our clinical practice. Our study contributes to the literature retrospectively by revealing the data of our hematology clinic patients.
There are basic restrictions in the presentation of study data and these restrictions are an obstacle to the statistical evaluation of the answers. The most important is the problems experienced in the standardization of IVIG products used for treatment. It was predicted that the statistical comparison of patients and responses would not be considered optimal because the products were not identical in terms of content. Prospective randomized double-blind controlled studies are required to clearly demonstrate its effectiveness, but it does not seem possible due to differences in content standardization, the amount and duration of dose per kilo used.
Important data have been revealed for the use of IVIG preparations in adult practice. Especially in the patient group before primary diagnosis, it is important to reveal the experience and to observe the responses carefully in terms of emergency approach to thrombocytopenia. It contains important data in terms of treatment and approach. In the literature, data on similar clinical conditions, emergency situations and their primary diagnoses are limited. Another important limitation in our study is that glucocorticosteroids were used in different doses and types in addition to IVIG for patients who used IVIG for immuntrombocytopenia, and therefore it is not possible to statistically evaluate the emergency IVIG response on an individual basis..
Many hematologic diseases and alloimmunization have been reported in the literature. (3,4) In particular, hemolysis and thrombocytopenia, which lead to frequent alloimmune-based frequent replacement needs, are clinically very important. Although different rates are reported in the literature, we see that alloimmunization-targeted IVIG use is only against thrombocytopenia in our patient group. Treatment success in these cases also results in a low rate similar to the literature.
Especially in the MDS group, there are studies with a wide array of alloimmunization ranging from15% to 59%. (24-26) However, it is necessary to stat that there are serious restrictions on treatment and outcomes in these study groups; optimization of the results is seen as the biggest problem.
In our hematology practice, IVIG can be used in cases of immune deficiency, often secondary to malignant hematological diseases or immunochemotherapies. In addition, immunosuppressive agents, malnutrition and aging cause the development of secondary immune deficiency. (7) Life-threatening infections may develop. Especially in patients with B cell lymphoproliferative diseases, with advanced stages of the disease or more, secondary immune deficiency develops. The use of Rituximab or Ibrutinib often leads to this result. CAR-T cell treatments, which are the current treatment options, can cause secondary immune deficiency. In the absence of neutropenia, the presence of an infection clinic affecting the patient’s 2 or more organs suggests the possibility of secondary immunodeficiency. In hematologic malignancies, it is recommended to be given subcutaneously or intravenously for 1 or 2 years and every 3-6 weeks, 200-400mg/kg/day. Baseline serum quantitative immunoglobulin value at diagnosis and ​​after treatment are recommended to be measured.