How IVIG Therapy Can Help Lymphoma Patients

Doctor standing over patients receiving IV therapy
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Something that people with lymphoma and other forms of blood cancer often deal with, whether as part of their disease or as a side effect of treatment, is decreased immune function and susceptibility to infection. Antibodies are proteins that stick to invaders and help the immune system fight infection. Different types, or classes, of antibodies are made to combat infections. Sometimes people with blood cancer have abnormal levels of just one class of antibody while others have more than one class affected (IgA and IgG are two classes of antibodies made by certain subsets of the body’s white blood cells; IgM is the third class). What are the effects of these abnormal levels, and how can they be treated?

Infections Can Result From Abnormal Antibody Levels

Recurrent infections, especially respiratory tract infections, are commonly seen in patients with Waldenström’s, a type of non-Hodgkin lymphoma, and may be related to the presence of low levels of antibodies—but it depends on which types of antibodies are missing.

For people who are deficient in IgA, a class of antibody that has an important role in the so-called mucous membranes, such as the lining of the airways and intestines), the link between IgA deficiency and frequent infection does not seem to be very strong. In fact, people who are born with a deficiency in this specific class of antibody often have no symptoms.

Doctors will often consistently test antibody levels. An interview of Waldenström’s survivor Jennifer Killam, a retired Air Force Major, explored the impact of a disease such as Waldenström’s on antibodies and immunity. All of her antibody levels were prone to being off. “My doctors need to keep a constant check on my antibody levels—IgA, IgG, and IgM. My IgM levels are under control, but I am not in remission,” said Killam.

In Major Killam’s type of lymphoma, and a variety of other blood cancers as well, the diseased cells produce excessive amounts of antibody protein that enter the bloodstream; in her case, it’s an excessive amount of IgM antibodies. One of her treatments attempts to bring these levels down to normal. Though her IgM levels are now down and in a healthier range, her IgG antibody levels are also low—too low—and IgG is a key infection-fighting antibody.

Normal IgG levels are above 800 mg/dL. Major Killam’s drops to 200 mg/dL, which causes her to be highly susceptible to disease. So, every six weeks she goes to City of Hope Medical Center for four to six hours to get her IgG levels back up. She receives an intravenous infusion known as IVIG.

Interestingly, not everyone with low levels of IgG seems to be susceptible to frequent infections. In patients with chronic lymphocytic leukemia, there is some debate about the appropriate use of IVIG, and many clinicians reserve this treatment for people who have low IgG but also exhibit repeated infections or difficulty clearing a persistent infection.

IVIG Therapy

IVIG is actually a therapy that has been around for decades and is used to treat patients with many different types of illnesses. The IV stands for intravenous and the IG stands for immunoglobulin (the scientific term for antibody proteins).

IVIG was first shown to be effective in a disease called autoimmune idiopathic thrombocytopenic purpura (ITP) in 1981. Since then, a long list of diseases that seem to respond well to IVIG has been growing. One of the major uses of IVIG is to replace a person’s antibody levels, but that is far from the only use.

IVIGs are products that can be hung in a bag for liquid administration into the veins. They are produced from pooled human plasma, meaning these bags contain IgG antibodies from different individuals, a variety of healthy donors, and the products typically contain more than 95 percent unmodified IgG, and only trace amounts of immunoglobulin A (IgA) or immunoglobulin M (IgM).

The collection of diseases that respond to IVIG is remarkable and the list perhaps demonstrates the importance of healthy immune function in all sorts of different illnesses.

The Uses of IVIG Therapy

Here is a sampling of uses for IVIG.

Immunodeficiency: This includes conditions that people are born with but also diseases that take a toll on the immune system like chronic lymphocytic leukemia (CLL) and multiple myeloma. Also included are cases of immunodeficiency that develop according to plan when therapies suppress the body’s antibody production.

Infections: In some cases, there are circumstances in which a person with frequent or recurring infections can benefit from IVIG. Certain viral infections, such as chronic parvovirus infection complicated by anemia, are included in this category.

Autoimmune/Inflammatory Conditions: In addition to autoimmune idiopathic thrombocytopenic purpura, for which IVIG was first shown effective in 1981, other conditions such as Guillain-Barré syndrome, Kawasaki disease, and HIV-associated diseases of the nerves are included in this category.

Other Conditions: Some diseases involving the nerves, called chronic neuropathies, are potentially improved with IVIG. Transfusion reactions and antibody-mediated organ transplant rejections also fall in this category.

Living With Waldenström’s, Dealing With Trade-Offs

Major Killam noted that, at this point, her disease is stable. Her treatments have brought her IgM levels down so that she does not have to worry as much about some of the complications of having excessive amounts of IgM.

When an excessive amount of protein enters the blood, doctors worry about something called hyperviscosity syndrome, or HVS. The signs and symptoms of HVS consist mostly of the three things: bleeding in the mucosa, or lining of various organs, visual changes, and symptoms that point to the nervous system as their source. General body symptoms including fatigue, weight loss or fever may also be present.

The therapies used to treat lymphoma are also not without their side effects. Some of the newer oral medications are prone to affect the digestive tract, with excessive diarrhea or constipation.

In the case of major Killam, it is not one single therapy that keeps her going but rather a regimen, and she draws from a variety of disciplines, including traditional medicine, acupuncture, chiropractic therapy, meditation, and yoga.

“All have proved helpful to my health—and my wellbeing as well. Oh, and laughter—laughter helps a lot. So sometimes, I just look in the mirror and laugh!”

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