Table 2.
When we look at the usage in patients which have a primary diagnosis before getting IVIG therapy; out of 87 patients (52.4%), 25 patients were diagnosed with ITP (28.7%), 7 patients with KLL (19.5%), 1 with autoimmune hemolytic anemia (1.1%), 1 with myelodysplastic syndrome (1.1% ), 3 CVID (3.4%), 4 with AML (4.6%), 1 (1.1%), 4 with Hodgkin lymphoma (4.6%), 7 with non-Hodgkin lymphoma (8%), 14 with multiple myeloma, 1 with Waldenström macroglobulinemia (1.1%), 1 with hairy cell leukemia (1.1%), 2 with PRCA (2.3%), 2 with AIDS (2.3%), 1with SLE (1.1%), 1 with Castleman Disease (1.1%) and 2 was diagnosed with sickle cell anemia (2.3%). Besides primary disease, the indications for IVIG use are given in Table 3. Immun thrombocytopenia is targeted in all cases diagnosed with ITP. It was used in the treatment of immune thrombocytopenia (23.5%) in 4 of 17 patients with CLL, secondary hypogammaglobulinemia in 11 (64.7%) and autoimmune hemolytic anemia in 2 (11.8%). It can be said that these rates are in line with the literature. Although different figures are mentioned in various publications, CLL-related autoimmune-origin cytopenia is reported on average around 20-25%. (6) In MDS, AML, ALL, AIDS and Waldenström patients with thrombocytopenia, IVIGs have been used off-label with the approval of the ministry of health in the treatment of secondary to immune-origin, resistant or alloimmunization. It has been observed that 5 (8%) of the 7 patients diagnosed with non-Hodgkin lymphoma have been administered IVIG therapy; it was used for the treatment of immune-induced thrombocytopenia in 5 (71.4%) and in 2 (28.6%) for the treatment of secondary hypogammaglobulinemia and secondary immune deficiency.
Of the 14 patients (16.1%) diagnosed with multiple myeloma, 5 (35.7%) had IVIG therapy for the treatment of alloimmune thrombocytopenia and 9 (64.3%) for secondary hypogammaglobulinemia. Table 3.
The patients and their distributions were evaluated according to the targets determined for the response. The expected response was 36.1% with 60 patients within the entire patient group. In 108 patients, the target response could not be obtained (63.9%). In the ITP patient group, the response was 56.1% out of a total of 37 patients; 8 patients in CLL (42.1%), 1 patient in autoimmune hemolytic anemia (100%), 3 patients in CVID (100%), 1 patient in ALL (12.5%), 1 patient in HL (25%), It resulted in 5 patients (35.7%) in MM, 1 patient in HCL (100%), 2 patients in PRCA (100%), 1 patient in AIDS (33.3%). In patients with primary diagnosis of MDS, AA, AML, NHL, WM, sickle cell anemia and Castleman Disease, the target response could not be obtained with various indications. Table 4.
The response was 58.5% with 24 patients in patients who were not diagnosed with any disease subgroup before getting IVIGs , were diagnosed with ITP with urgent and deep thrombocytopenia after IVIG usage . No response was obtained in other patients. Table 5.
In patients who were diagnosed with a primary disease prior to the usage of IVIGs; considering the various indications, usage and responses mentioned previously: 52% with 13 patients in ITP, 47.1% with 8 patients in CLL, 100% with 3 patients in CVID, and 100% with 1 patient in ALL , 25% with 1 patient in Hodgkin Lymphoma, 35.7% with 5 patients in multiple myeloma, 100% with 1 patient in Waldenström Macroglobulinemia and HCL, 50% with 1 patient in PRCA, sickle cell anemia and AIDS. Table 6.
Table 7 shows the patients used for prophylaxis. The distribution of patients who are preferred for the treatment of secondary hypogammaglobulinemia and secondary immunodeficiency can be seen. Out of 21 patients, 6 were diagnosed with multiple myeloma (28.6%), 6 with KLL (28.6%), 3 with non-Hodgkin lymphoma (14.3%), 1 with Hodgkin Lymphoma (4.8%), 3 with CVID (% 14.3) and 2 of them were diagnosed with sickle cell anemia (9.5%). Two patients with sickle cell anemia were otosplenectomized; it should be noted that they received treatment with the indication of secondary hypogammaglobulinemia.