Preemptive intravenous immunoglobulin allows safe and timely administration of antineoplastic therapies in patients with multiple myeloma and parvovirus B19 disease

Abstract

Parvovirus B19 can cause severe disease in myeloma patients including ASCT recipients. Thrombocytopenia - not anemia - was the leading presentation and may be associated with autoimmune conditions. Patients with unexplained cytopenias, particularly when prolonged, should undergo testing for circulating parvovirus. A reduction in viral load was associated with response to IVIG, although additional therapy was needed for recurrent disease. Most importantly, preemptive IVIG allowed for safe and timely administration of antineoplastic therapy in patients with ongoing B19 disease.

Human parvovirus B19: A review

“…Good hand washing is critical and the most important single method of infection control (Katragadda et al, 2013). Close contact with individuals who have respiratory symptoms or fever should be avoided when possible and frequent hand washing is advised (Leifeldt et al, 2002).…”

Persistent parvovirus B19 infection resulting in red cell aplasia after allogeneic hematopoietic stem cell transplantation

“…In contrast, it has been reported that persistent PVB infection could be established in immunosuppressed conditions where the ability to constitute effective antiviral immunity is severely impaired. These conditions include human immunodeficiency virus infection, hematological diseases, HSCT, and solid organ transplantation . In addition to our case, only one case of MM has been reported in which persistent PVB infection was documented and caused RCA .…”

“…Regarding the doses of immunoglobulin, our patient responded well with a relatively lower dose (in total 300 mg/kg) compared with the previously reported doses ranging between 1500 and 4000 mg/kg . Because of the high cost of high‐dose IVIg administration, the efficacy of lower doses should be investigated by accumulating the outcomes of patients treated with lower doses.…”

“…Primary infection causes RCA in the specific conditions where red blood cell survival time is shortened; however, the duration between the primary infection and development of RCA has not been demonstrated. Those conditions include hemolytic disorders, pregnancy, and hematopoietic recovery phase after anti‐cancer chemotherapy . In contrast, it has been reported that persistent PVB infection could be established in immunosuppressed conditions where the ability to constitute effective antiviral immunity is severely impaired.…”

“…The standard treatment for PVB infection in immunocompromised patients has yet to be established; however, evidence has been accumulating for the efficacy of IVIg . IVIg treatment makes sense because humoral immunity plays a crucial role in the protection against PVB infection, and available immunoglobulin formulations universally contain anti‐PVB IgG.…”