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IVIG for Myeloma?
Should patients with reduced immune function consider IVIG for myeloma? What are the risks and rewards of undergoing IVIG therapy for the multiple myeloma patient?
The two key risks listed below that I believe are critical for myeloma patients to understand is that:
- IVIG can occasionally cause kidney injury, particularly in patients with pre-existing renal impairment or those receiving high-dose or sucrose-containing IVIG products.
- IVIG therapy can increase the risk of blood clots, particularly in patients who are already at higher risk due to myeloma-related factors (e.g., hyperviscosity, immobility).
According to research, 20% of MM patients are diagnosed with kidney involvement. This percentage increases to 50% with time. Meaning there are conventional therapies that cause kidney damage in addition to MM.
Both MM and certain chemo regimens can cause blood clots. I had two blood clots during my conventional therapies.
Lastly, IVIG is expensive. Get approval from your health insurance before you undergo IVIG therapy.
5 IVIG Facts
What are the risks and benefits for myeloma patients considering IVIG therapy?
Benefits
- Reduction in Infections:
- IVIG can help prevent bacterial and viral infections by providing passive immunity, particularly in patients with recurrent or severe infections due to weakened immune systems.
- Improved Quality of Life:
- Fewer infections can lead to less hospitalizations, reduced antibiotic use, and improved overall health and well-being.
- Support During Active Therapy:
- Myeloma treatments like chemotherapy and stem cell transplants can further suppress the immune system. IVIG provides additional protection during these high-risk periods.
- Anti-Inflammatory Effects:
- IVIG has immunomodulatory properties that can help manage autoimmune complications or inflammatory side effects that may occur with myeloma.
Risks
- Allergic Reactions:
- Some patients may experience allergic or hypersensitivity reactions to IVIG. Symptoms include rash, itching, or in rare cases, anaphylaxis.
- Thromboembolic Events:
- IVIG therapy can increase the risk of blood clots, particularly in patients who are already at higher risk due to myeloma-related factors (e.g., hyperviscosity, immobility).
- Renal Dysfunction:
- IVIG can occasionally cause kidney injury, particularly in patients with pre-existing renal impairment or those receiving high-dose or sucrose-containing IVIG products.
- Headache and Migraine:
- Post-infusion headaches, including aseptic meningitis, can occur, though these are typically mild and transient.
- Infection Risk from IVIG Preparation:
- While IVIG is screened and purified to prevent contamination, there is a theoretical risk of transmission of bloodborne pathogens.
- Cost and Accessibility:
- IVIG therapy is expensive and may not be easily accessible for all patients, which can affect its feasibility as a long-term treatment option.
Considerations
- Patient Selection:
- IVIG is typically reserved for patients with recurrent infections and low IgG levels that do not respond well to other preventive measures like vaccination.
- Monitoring:
- Patients undergoing IVIG therapy should be closely monitored for adverse effects, particularly those with renal or cardiovascular issues.
Reduced immune function can be a serious problem for MM patients. As I’ve mentioned in previous posts, 50% of MM patients die, not from MM but from infection. Just handle IVIG with care.
Email me at David.PeopleBeatingCancer@gmail.com with questions about your immune system.
Thanks,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Adverse Effects of Immunoglobulin Therapy
Abstract
Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported.
The majority of these events, such as
- flushing,
- headache,
- malaise,
- fever,
- chills,
- fatigue and
- lethargy,
are transient and mild. However, some rare side effects, including
- renal impairment,
- thrombosis,
- arrhythmia,
- aseptic meningitis,
- hemolytic anemia, and
- transfusion-related acute lung injury (TRALI),
are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis…
Classification of Adverse Effects
Adverse effects are classified as immediate or delayed depending on the time of occurrence. Immediate adverse effects mainly include flu-like syndrome, dermatologic side effects, arrhythmia, hypotension, and transfusion-related acute lung injury (TRALI). Immediate side effects are categorized as mild, moderate, and severe.
Mild adverse effects include light headache, fever, chills, and fatigue; they are alleviated when the infusion is slowed down or when antihistamines and nonsteroidal anti-inflammatory drugs (NSAIDs) are administered.
Moderate adverse effects include chest pain, anhelation, vomiting, arthralgia, and severe headache; these effects require the infusion to be discontinued or antihistamines and NSAIDs to be administered.
Severe adverse effects include hypertension, anaphylaxis, bronchospasm, and altered consciousness; these adverse effects require the infusion to be stopped immediately and for corresponding medical attention to be provided (22).