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Updated: May 8, 2026
Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
Published on: November 26, 2018
Intravenous Immunoglobulin Reduces Infections for Patients with Chronic Lymphocytic Leukemia: A Single-Center
Nirja N Shah1, Tulsi Patel1, Thomas J Kipps1,2,3,4
1Department of Medicine, UC San Diego, La Jolla, California.
Abstract:
Hypogammaglobulinemia is common in patients with chronic lymphocytic leukemia (CLL). Prior studies demonstrated that intravenous immunoglobulin (IVIG) reduced infections without survival benefit. We conducted a single-institution retrospective cohort study of infectious outcomes in patients with CLL who received IVIG between 2005 and 2022 to assess the impact of IVIG across evolving CLL treatment paradigms, including the introduction of targeted agents. Fifty-two patients met the inclusion criteria of IVIG use for hypogammaglobulinemia and recurrent infections, with also any infection up to 1 year prior to the initiation of IVIG. Baseline mean IgG prior to IVIG was 389 mg/dL (range, 93-891 mg/dL). By design, all 52 patients (100%) experienced at least one CTCAE grade ≥2 infection in the 12 months prior to IVIG initiation. In the 12 months following IVIG initiation, only 17 patients (33%) experienced a grade ≥2 infection. IVIG therapy was associated with a 67% reduction in risk of grade 2 infections (RR 0.33; 95% confidence interval, 0.22-0.48; P < 0.0001), corresponding to an absolute risk reduction of 67% and a number needed to treat of 1.5. The mean number of infections per patient also reduced from 2.1 to 0.4. Baseline IgA and IgG levels, as well as recent CLL treatment, were not predictors of residual post-IVIG infections. These findings suggest that IVIG may yield meaningful improvements in patient quality of life by reducing infections.
Significance:
Hypogammaglobulinemia and recurrent infections remain a complication of CLL, despite contemporary agents. In this 2005 to 2022 retrospective cohort, IVIG initiation was associated with a large reduction in CTCAE grade ≥2 infections: only 33% of patients had a post-IVIG grade ≥2 infection versus all patients before IVIG. Residual infections were not explained by baseline IgG/IgA levels or recent therapy. IVIG may be an effective supportive-care strategy in patients with CLL.
