A clinician survey for management of the secondary immunodeficiency caused by hematological malignancies in China

Abstract

Unlike Western countries, there are still few clinical immunology specialists in China, and the optimal care for secondary immunodeficiency caused by hematological malignancies is unknown. Therefore, we initiated this clinician survey study to describe the current situation of the care for malignancy patients with hypogammaglobulinemia in China. We adapted a previously published online questionnaire of current clinical practices regarding the management of secondary immunodeficiency caused by hematological malignancies and then distributed the questionnaire to 52 hematologists in China via WeChat mobile software; the survey collected demographic details, starting dosage, target immunoglobulin (Ig) level, monitoring, criteria for stopping Ig replacement, vaccination use, and oral antibiotic prophylaxis for hypogammaglobulinemia patients. Forty-eight hematologists responded. 28(58.33%) respondents had more than 10 years of experience. Nevertheless, 40(83.33%) respondents reported that they did not use any specific criteria for prophylactic Ig replacement in hypogammaglobulinemia patients. However, 27(56.25%) respondents reported that they had used intravenous immunoglobulin (IVIG); however, the starting dose, frequency, and target Ig level were significantly varied. Additionally, the criteria for stopping Ig replacement were significantly varied. Only one respondent (2.08%) used subcutaneous immunoglobulin (SCIG). Moreover, 35(72.92%) respondents reported no vaccination prior to Ig replacement, and 47(97.92%) respondents reported that they had not used antibiotic prophylaxis in secondary hypogammaglobulinemia patients. Official guideline for the care for secondary immunodeficiency (SID) of the hematological malignancies patients should be issued in China, and significant attention of the hematologists should be paid to the use of prophylactic antibiotics and Ig replacement for the care of patients with hypogammaglobulinemia caused by hematological malignancies, as these agents could significantly reduce the infection rate in China.

Access and use of immunoglobulins in secondary supportive cancer care: A systematic literature review

“…A total of 43 articles relevant to the topic of IgRT in HMs were identified within the period of 2012–2022. Of these articles, 4 were qualitative studies, 12 , 27 – 29 10 were narrative literature syntheses which featured expert opinions, 17 , 30 – 38 1 was a systematic review, 39 15 were retrospective case-controlled cohort studies, 40 – 53 , 67 1 was a non-randomised control trial, 54 1 was a mixed-methods cohort study, 55 4 were case reports, 56 – 59 6 were prospective case-controlled studies 60 – 65 and 1 was a randomised placebo-controlled trial 66 ( Figure 2) . On first glance, it could be argued that these data demonstrate a lack of rigour in the studies conducted; however, in reality, the study of medicine use and access is often best investigated using cohort studies as they provide a realistic source of data and are more cost-effective and cause less disruption to healthcare provision than randomised control trials.…”

“…12,17,30,[32][33][34][35][37][38][39]43,[47][48][49]51,53,57,58,[60][61][62][63][64]66 Others focused on topics, such as clinicians' opinion of SID and its' management and diagnosis. [27][28][29] Three studies placed a specific focus on immunoglobulin withdrawal 31,44,54 and six studies considered factors causing an increase in the incidence of Hypogammaglobulinemia (HGG) in HM, such as chemotherapy. 36,45,50,56,59,65 RoB and QA results…”

“…Hence, now is the time to invest resources into addressing the topic of immunoglobulin use, so that patients can continue to access IgRT as a supportive cancer treatment in HM. Geographical location: China (n = 2), 27,46 France (n = 3), 34,48,64 Oceania -Australia/New Zealand (n = 2), 29,40 United States (n = 7), 43,45,[52][53][54]58,63 Italy (n = 7), 33,41,47,49,50,66,67 Sweden (n = 1), 55 Japan (n = 1), 56 Spain (n = 2), 35,42 United Kingdom (n = 2), 44,61 Germany (n = 2), 60,62 Belgium (n = 1), 37 Greece (n = 1) 51 and India (n = 1). 65…”

“… Geographical location: China ( n = 2), 27 , 46 France ( n = 3), 34 , 48 , 64 Oceania – Australia/New Zealand ( n = 2), 29 , 40 United States ( n = 7), 43 , 45 , 52 – 54 , 58 , 63 Italy ( n = 7), 33 , 41 , 47 , 49 , 50 , 66 , 67 Sweden ( n = 1), 55 Japan ( n = 1), 56 Spain ( n = 2), 35 , 42 United Kingdom ( n = 2), 44 , 61 Germany ( n = 2), 60 , 62 Belgium ( n = 1), 37 Greece ( n = 1) 51 and India ( n = 1). 65 …”

Chemotherapy of hematological malignancies in patients with COVID-19

“…Лечение пациентов с онкогематологическими за болеваниями представляет собой особую проблему в условиях пандемии COVID19 (COronaVIrus Disease 2019). Вторичный иммунодефицит, возникающий на фоне течения злокачественных заболеваний систе мы крови, а также вследствие специфического про тивоопухолевого лечения, повышает риск развития вирусных, бактериальных и грибковых инфекционных осложнений в данной группе пациентов [1,2]. В связи с этим пациенты с сопутствующей онкогематологи ческой патологией имеют более высокий риск зараже ния вирусом SARSCoV2, а также предрасположен ность к тяжелому течению коронавирусной инфекции.…”