Secondary Immune Deficiency Disorder Clinical Trial
Official title:
A Prospective Case Series of Subcutaneous Immunoglobulin for Prophylaxis of Infections in Patients With Chronic Lymphocytic Leukemia With Impaired Humoral Immunity
Verified date | August 2020 |
Source | Rochester General Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Patients with chronic lymphocytic leukemia (CLL) are at increased risk of infections as compared to age matched controls, with infections being a major cause of morbidity and mortality. Previous studies have shown that patients with CLL have both hypogammaglobinemia and impaired humoral immunity as defined by vaccine responses to both polysaccharide and peptide antigens. Attempts at decreasing infections in CLL have included therapy with prophylactic antibiotics and intravenous immunoglobulin. In general clinical practice and in previous studies, patients have started IV immunoglobulin replacement therapy if they have a history of serious infection or hypogammaglobinemia (defined as Immunoglobulin G below 500-600 g/dL), but vaccine responses have not been evaluated. This study will identify CLL patients with humoral immunodeficiency by checking both Ig levels and vaccines responses. In patients with impaired humoral immunity, the investigators will use subcutaneous immunoglobulin replacement to show this intervention will increase Ig levels, protective antibody titers, and be well tolerated.
Status | Completed |
Enrollment | 20 |
Est. completion date | July 3, 2020 |
Est. primary completion date | July 3, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Diagnosis of chronic lymphocytic leukemia - Medically stable, with expected survival of > 1 year - Able to understand and willingness to sign a written informed consent - Able to comply with study procedures Exclusion Criteria: - Previously diagnosed primary immunodeficiency - Additional immunosuppressive states as assessed by the primary or co investigators - Ongoing therapy with Ig replacement - Serum IgG < 500 mg/dL |
Country | Name | City | State |
---|---|---|---|
United States | Allergy, Immunology, Rheumatology at Rochester Regional Health | Rochester | New York |
Lead Sponsor | Collaborator |
---|---|
Rochester General Hospital |
United States,
Berger M. Adverse effects of IgG therapy. J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):558-66. doi: 10.1016/j.jaip.2013.09.012. Epub 2013 Oct 31. — View Citation
Chapel H, Dicato M, Gamm H, Brennan V, Ries F, Bunch C, Lee M. Immunoglobulin replacement in patients with chronic lymphocytic leukaemia: a comparison of two dose regimes. Br J Haematol. 1994 Sep;88(1):209-12. — View Citation
Compagno N, Cinetto F, Semenzato G, Agostini C. Subcutaneous immunoglobulin in lymphoproliferative disorders and rituximab-related secondary hypogammaglobulinemia: a single-center experience in 61 patients. Haematologica. 2014 Jun;99(6):1101-6. doi: 10.3324/haematol.2013.101261. Epub 2014 Mar 28. — View Citation
Cooperative Group for the Study of Immunoglobulin in Chronic Lymphocytic Leukemia, Gale RP, Chapel HM, Bunch C, Rai KR, Foon K, Courter SG, Tait D. Intravenous immunoglobulin for the prevention of infection in chronic lymphocytic leukemia. A randomized, controlled clinical trial. N Engl J Med. 1988 Oct 6;319(14):902-7. — View Citation
Dhalla F, Lucas M, Schuh A, Bhole M, Jain R, Patel SY, Misbah S, Chapel H. Antibody deficiency secondary to chronic lymphocytic leukemia: Should patients be treated with prophylactic replacement immunoglobulin? J Clin Immunol. 2014 Apr;34(3):277-82. doi: 10.1007/s10875-014-9995-5. Epub 2014 Feb 21. Review. — View Citation
Dicato M, Chapel H, Gamm H, Lee M, Ries F, Marichal S, Wirth C, Griffith H, Brennan V. Use of intravenous immunoglobulin in chronic lymphocytic leukemia. A brief review. Cancer. 1991 Sep 15;68(6 Suppl):1437-9. Review. — View Citation
Friman V, Winqvist O, Blimark C, Langerbeins P, Chapel H, Dhalla F. Secondary immunodeficiency in lymphoproliferative malignancies. Hematol Oncol. 2016 Sep;34(3):121-32. doi: 10.1002/hon.2323. Epub 2016 Jul 12. Review. — View Citation
Gardulf A. Immunoglobulin treatment for primary antibody deficiencies: advantages of the subcutaneous route. BioDrugs. 2007;21(2):105-16. Review. — View Citation
Lachance S, Christofides AL, Lee JK, Sehn LH, Ritchie BC, Shustik C, Stewart DA, Toze CL, Haddad E, Vinh DC. A Canadian perspective on the use of immunoglobulin therapy to reduce infectious complications in chronic lymphocytic leukemia. Curr Oncol. 2016 Feb;23(1):42-51. doi: 10.3747/co.23.2810. Epub 2016 Feb 18. Review. — View Citation
Lingman-Framme J, Fasth A. Subcutaneous immunoglobulin for primary and secondary immunodeficiencies: an evidence-based review. Drugs. 2013 Aug;73(12):1307-19. doi: 10.1007/s40265-013-0094-3. Review. — View Citation
Looney RJ, Huggins J. Use of intravenous immunoglobulin G (IVIG). Best Pract Res Clin Haematol. 2006;19(1):3-25. Review. — View Citation
Molica S, Musto P, Chiurazzi F, Specchia G, Brugiatelli M, Cicoira L, Levato D, Nobile F, Carotenuto M, Liso V, Rotoli B. Prophylaxis against infections with low-dose intravenous immunoglobulins (IVIG) in chronic lymphocytic leukemia. Results of a crossover study. Haematologica. 1996 Mar-Apr;81(2):121-6. — View Citation
Oscier D, Dearden C, Eren E, Fegan C, Follows G, Hillmen P, Illidge T, Matutes E, Milligan DW, Pettitt A, Schuh A, Wimperis J; British Committee for Standards in Haematology. Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia. Br J Haematol. 2012 Dec;159(5):541-64. doi: 10.1111/bjh.12067. Epub 2012 Oct 11. Erratum in: Br J Haematol. 2013 Apr;161(1):154. Erem, Efrem [corrected to Eren, Efrem]. Br J Haematol. 2013 Mar;160(6):868. Dosage error in article text. — View Citation
Raanani P, Gafter-Gvili A, Paul M, Ben-Bassat I, Leibovici L, Shpilberg O. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006501. doi: 10.1002/14651858.CD006501.pub2. Review. — View Citation
Sánchez-Ramón S, Dhalla F, Chapel H. Challenges in the Role of Gammaglobulin Replacement Therapy and Vaccination Strategies for Hematological Malignancy. Front Immunol. 2016 Aug 22;7:317. doi: 10.3389/fimmu.2016.00317. eCollection 2016. Review. — View Citation
Twomey JJ. Infections complicating multiple myeloma and chronic lymphocytic leukemia. Arch Intern Med. 1973 Oct;132(4):562-5. — View Citation
Ueda M, Berger M, Gale RP, Lazarus HM. Immunoglobulin therapy in hematologic neoplasms and after hematopoietic cell transplantation. Blood Rev. 2018 Mar;32(2):106-115. doi: 10.1016/j.blre.2017.09.003. Epub 2017 Sep 19. Review. — View Citation
Vacca A, Melaccio A, Sportelli A, Solimando AG, Dammacco F, Ria R. Subcutaneous immunoglobulins in patients with multiple myeloma and secondary hypogammaglobulinemia: a randomized trial. Clin Immunol. 2018 Jun;191:110-115. doi: 10.1016/j.clim.2017.11.014. Epub 2017 Nov 28. — View Citation
* Note: There are 18 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Identify patients with CLL with humoral immunodeficiency despite serum IgG > 500 mg/dL. | Incidence of humoral immunodeficiency | 10 months | |
Primary | Number of patients who increase IgG to above 700 mg/dL | Effectiveness of Hizentra to change IgG levels | 10 months | |
Secondary | Number of patients who increase diphtheria IgG to above 0.1 IU/mL, tetanus IgG to above 0.1 IU/mL, and IgG to streptococcus pneumonia to above 1.3 mcg/mL | Effectiveness of Hizentra to change specific antibody titers in CLL | 10 months | |
Secondary | Number of subjects with treatment-related adverse effects as assessed by CTCAE v4.0 | Safety and tolerability of Hizentra in CLL | 10 months | |
Secondary | Quality of life (Short Form 36) on subcutaneous Ig replacement therapy a 0-100 scale, with lower scores indicating higher disability/lower quality of life | Does Hizentra change quality of life scores in patients with CLL | 10 months | |
Secondary | Track the number of infections requiring antibiotics, further characterized per severity as defined in previous studies | Does Hizentra change the rate of non-neutropenic infections in CLL | 10 months |