Treating patients with B-cell non-Hodgkin lymphoma with immunoglobulin replacement therapy after rituximab treatment

The study evaluated the outcomes of immunoglobulin replacement (IgR) therapy in patients with B-cell non-Hodgkin lymphoma (B-NHL) and immunodeficiency, who were previously treated with rituximab (Rituxan). The authors found that IgR was safe and effective to increase serum immunoglobulins in such patients.

B-NHL happens when there is a cancerous growth in the white cells called B-lymphocytes in the blood. Rituximab is an immunotherapy used for treating B-NHL. However, rituximab causes a lack of gammaglobulins (IgG). IgG is an important immunoglobulin that fights infections.

Previously, a lack of IgGs and nonneutropenic infections (NNIs) were mitigated by IgR in patients under rituximab treatment. NNIs occur due to other reasons than lack of neutrophils, which are also infection preventing white blood cells. Immunodeficiency and IgR’s outcomes in patients with B-NHL under rituximab therapy are not clear.

The study included 15 patients with B-NHL who received rituximab within the past 2 years. They were given vaccines against tetanus, diphtheria, and pneumonia. IgG levels were measured before vaccination. Overall, the average IgG level was 628 mg/dL. 20% of patients responded to diphtheria vaccination, 6.7% to tetanus, and 20% responded to pneumonia vaccination. Their IgG levels were elevated upon vaccination. A total of 13 patients were designated as immunodeficient because of an insufficient increase in IgG levels. 10 out of 13 patients agreed to have IgR injections under the skin for 52 weeks.

Their average IgG level was 577 mg/dL before IgR. It increased to 967 mg/dL after 12 weeks and to 1022 mg/dL after 52 weeks of IgR. These patients experienced 17 cases of NNI in the 12 months before starting IgR. These were reduced to 6 during 12 months of IgR. Overall, IgR was well tolerated. Mild side effects, such as redness of injection sites and daily sweating were reported. No patient had any severe reaction to injections affecting their whole body.

The study concluded that patients with B-NHL treated by rituximab had immunodeficiency. IgR was well-tolerated and effective to raise IgG levels in such patients. IgR may also reduce antibiotic-dependence for the treatment of NNIs.

This was a small study. It also did not compare IgR’s efficacy with any control treatment. The authors suggested that IgR may also reduce antibiotic-dependence for the treatment of NNIs.