Management of humoral secondary immunodeficiency in hematological malignancies and following hematopoietic stem cell transplantation: Regional perspectives

Ar M.C. El Fakih R. Gabbassova S. Alhuraiji A. Nasr F. Alsaeed A. Sayinalp N. Marashi M.
October 2023 Elsevier Ltd

Leukemia Research
2023 #133

Secondary immunodeficiency (SID) can occur as a result of multiple factors, including hematological malignancies, hematopoietic stem cell transplantation (HSCT), immunosuppressive treatment, biologics, and anti-inflammatory drugs. SID includes disorders resulting from impairment of both cellular and humoral immunity. This review focuses on the current risk factors, implications, and challenges in managing SID patients with impaired humoral immunity, which includes quantitative (hypogammaglobulinemia) and/or functional antibody and B-cell deficiencies specifically related to hematological malignancies and post-HSCT. Increased physician awareness is needed surrounding the disease presentation and early risk factors, as SID may be caused by several etiologies. Careful clinical assessment is then required to optimize management, which encompasses close monitoring of clinical parameters, vaccination, antibiotic prophylaxis, and immunoglobulin replacement therapy (IGRT). Novel methods of IGRT administration are associated with enhanced pharmacokinetics, IgG trough level stability, no need for venous access, as well as fewer systemic adverse events and better administration flexibility compared with traditional methods. Published international guidelines supported by observations from clinical data are broadly followed; however, best practices within each country have nuances that underline the need to tailor treatment plans to the individual patient.

Chronic lymphocytic leukemia , Hematological malignancies , Hematopoietic stem cell transplantation , Humoral immunodeficiency , Hypogammaglobulinemia , Immunoglobulin replacement therapy , Lymphoma , Multiple myeloma , Secondary immunodeficiency

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Division of Hematology, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University, Cerrahpaşa, Istanbul, Turkey
Oncology Center, Section of Stem Cell Transplant and Cellular Therapy, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
Center for Hematology and Bone Marrow Transplantation, Kazakh Scientific Research Institute of Oncology and Radiology, Almaty, Kazakhstan
Al-Farabi Kazakh National University, Almaty, Kazakhstan
Department of Hematology, Kuwait Cancer Control Center, Kuwait City, Kuwait
Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
Department of Hematology, Hacettepe University Medical School, Ankara, Turkey
Department of Hematology, Mediclinic City Hospital, Dubai, United Arab Emirates

Division of Hematology
Oncology Center
Center for Hematology and Bone Marrow Transplantation
Al-Farabi Kazakh National University
Department of Hematology
Department of Hemato-Oncology
Princess Noorah Oncology Center
College of Medicine
Department of Hematology
Department of Hematology

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