Re: Immune suppresion

[Guest guest]

Louise

Having low antibodies (hypogammaglobulinemia) is quite common in CLL patients,

perhaps up to 75% of patients. The level of the low antibodies, and the quality

of the remaining antibiodies, differentiate those who run into trouble from

recurrent infections from those who do not. Infusions of antibodies (IV Ig or

IVIG or gammaglobulin infusions) are very helpful in preventing recurrent

infections. The current recommendations are for patients who are

hypogammaglobulinemic and:

1) have recurrent infections

2) a single life threatening infection

3) chronic sinusitis or bronchietasis

The only patients who develop problems from IV Ig are those patients who are IgA

deficient. This means not just having low IgA levels, but no IgA. The IgA

deficiency needs to have been present since childhood in order to be a problem.

What happens is that you can develop an allergic reaction that can result in

anaphylaxis when exposed to IV Ig.

If your IgA was normal in 4/06, you are not going to develop an allergy and

should be able to tolerate IV Ig. It is not uncommon for people to develop

low-grade fevers and chills during the infusions, but not much more.

With regard to your case, you really sound as if you would benefit from IV Ig

and should be able to tolerate it.

Rick Furman, MD

>

>

> Hi ,

> Thank you for Dr. Keating's email - even though he chose not to respond to

> my research question. With my lack of technical skill, I was wondering if

> you would consider posting the following for me on your CIG discussion

> group.

> Immune Suppression Question:

> Has anyone else ever experienced immune suppression problems from IgA

> deficiency following chemotherapy? This has greatly negatively impacted my

> quality of life, and caused me many problems - including frequent respiratory

> infections and 4 bouts of pneumonia this year. My Kaiser medical providers

> just recommend continually taking antibiotics and tell me taking Vit C,

> etc. could make me even more susceptible to pneumonia. They have ruled out

> trying gamma globulin, because I developed allergic reactions to many

> medications following 6 months of chemotherapy 3 years ago.

> I would be greatly appreciative if anyone knows of any possible experts

> world wide who might be knowledgeable about such immune suppression problems,

> or if anyone has any suggestions regarding research institutions anywhere

> in the world that might be helpful.

> Many thanks, Louise

> louise@...

> PS In case anyone is curious to know more about my situation, here is some

> info about it: My IgA deficiency was noted following 6 months of

> chemotherapy given 3 years ago for an unclear leukemia †" lymphoma

diagnosis. (Dx

> then included: Stanford - CLL/PLL; City of Hope - CLL/SLL; Rush Hospital -

non

> Hodgkin’s lymphoma with a leukemia aspect; UCLA †" atypical CLL/SLL with

> increased prolymphocytes; Kaiser †" lymphoproliferative disorder that may

> include CLL, SLL, B cell PLL, splenic marginal zone lymphoma, variant of

> mantel cell lymphoma). Chemotherapy primarily included Fludarabine and

Rituxan

> with Prednisone, etc. (Cytoxan 1st briefly prescribed but D/C after WBC

> rose above previous 80,000). My IgA, which was normal in 04/06, now remains

> under 6 mg/dl (normal range 40 †" 375), and is apparently considered the

cause

> of my unfortunate immune suppression situation.

> Thanks everyone again, Louise

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