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.