Protocolización del tratamiento con gammaglobulinas en el paciente con malignidad hematológica

Abstract

Secondary immunodeficiency (SID) due to hematological malignancy (HM) represents a health problem concern and an important challenge due to high rate of morbidity and mortality associated with recurrent and severe infections. Initial assessment of specific antibody (Ab) responses – after polysaccharide 23-valent pneumococcal (PPV-23) and tetanus toxoid (TT) protein vaccine- in HM was proposed in the 80's as a more reliable predictor of infections to start immunoglobulin replacement therapy (IgRT). Patients affected by hematological malignancy, in particular chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), were recognized as presenting Ab production deficits many years ago. However, it was not until 2019 when a new indication of the European Medicines Agency (EMA) has included the defect of specific Ab response as an indication for IgRT in SID with recurrent infections, allowing the inclusion of other HM patients, such as non-Hodgkin's lymphoma (NHL) or gammopathy of uncertain significance (MGUS). However, interpretation of pure polysaccharide 23-valent immunization is hampered by the high endemicity of pneumococcal disease and the generalization of the 13-valent adjuvant pneumococcal vaccination (PCV-13). Specific IgG anti-Salmonella typhi Ab response has been proposed as a biomarker of risk of infection complementary to PCV-13 and TT in primary immunodeficiency (PID)...