From the Guidelines
Patients with low gamma globulin levels should be considered for immunoglobulin replacement therapy (IgRT) if they have severe or repeated infections, with a target trough of 600-800 mg/dL, as this has been shown to decrease major and clinically documented infections 1. When managing hypogammaglobulinemia, it is crucial to monitor serum immunoglobulin levels and consider IgRT in patients with chronic lymphocytic leukemia (CLL) and recurrent or severe infections.
- The use of prophylactic IgRT has been associated with a significant decrease in major and clinically documented infections in patients with CLL and multiple myeloma 1.
- A recent study suggested that the introduction of IgRT significantly reduced the risk of severe infectious complications in hematologic patients, including those receiving BTK-I for CLL 1.
- Subcutaneous immunoglobulin therapy (SCIg) has been shown to be an effective therapeutic option, with higher increases in IgG levels compared to intravenous Ig (IVIg) and a significant reduction in infectious episodes 1.
- The recommended dosage for IgRT is 0.2-0.4 g/kg body weight every 3 to 4 weeks, or an equivalent dose of SCIg administered usually one or twice a week, with the goal of reaching a target trough of 600-800 mg/dL 1.
- It is essential to investigate the underlying cause of low gamma globulin levels, as it could result from primary immunodeficiency disorders, certain medications, protein-losing conditions, or hematologic malignancies, and to practice preventive measures like good hygiene and promptly treating infections.
From the Research
Definition and Causes of Low Gamma Globulin
- Low gamma globulin, also known as hypogammaglobulinemia, is a condition characterized by low levels of immunoglobulins (antibodies) in the blood 2.
- This condition can be caused by primary immunodeficiency diseases, which are disorders in which the immune system is impaired, or secondary immunodeficiency diseases, which are disorders that occur as a result of another condition or treatment 3.
Symptoms and Diagnosis of Low Gamma Globulin
- Symptoms of low gamma globulin include recurrent infections, autoimmunity, allergies, and neoplasias 2.
- Diagnosis is typically made through blood tests that measure immunoglobulin levels, and may involve other tests to rule out underlying conditions 2.
Treatment Options for Low Gamma Globulin
- Immunoglobulin replacement therapy (IgRT) is the standard treatment for primary immunodeficiency diseases, and involves the administration of immunoglobulins to replace those that are lacking in the body 4, 5.
- There are two main types of IgRT: intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG), each with its own benefits and drawbacks 4, 5.
- IVIG is typically used for acute illnesses, while SCIG can be used for long-term treatment and has been shown to have a more favorable impact on quality of life and treatment satisfaction 5, 3.