Know Your Options Against Infections - Immunoglobulin Infusions (IVIG) for People with CLL

Why Am I at High Risk for Infections? 

Chronic lymphocytic leukemia (CLL) is the result of an overproduction of B-cells, which are white blood cells that make antibodies. The overproduction of B-cells is caused by mutations that prevent them from effectively fighting infections and result in them taking up extra space in the bone marrow. As a result, there is a reduced production of healthy white blood cells that are essential for fighting off infections.

Normally, if a B-cell comes across a harmful substance, cancer cell, or microorganism (all of them are also known as pathogens), it produces antibodies that activate other immune cells and create an inflammatory response. This will ensure that whatever substance is detected is effectively eliminated.  The B-cell will lock onto the pathogen, ensuring it does not replicate and won’t infect other cells. 

Additionally, treatments such as venetoclax and BTK inhibitors, although being considered targeted therapies and, therefore, very selective to kill only cancer cells, can still affect the growth of healthy B-cells, debilitating the immune response as a consequence. 

Because of the combination of all these factors, it’s common for patients with CLL to be more prone to getting sick from infections, even when they are not undergoing any treatment. Since they have a weakened immune system, it’s important to have supportive measures in place that ensure their good health and prevent any serious complications. 

What Measures Can You Take if You Have a Weakened Immune System? 

• Eat nutrient-dense foods to boost your immune system.
• Increase antioxidant-rich foods to reduce oxidative stress. 
• Stay hydrated; you can have warm water, and it’s easier for your body to regulate the temperature when you ingest warm water instead of cold. 
• Increase low-impact or mild exercise time to maintain a good muscle mass percentage and boost your immune system and metabolism.
• Some health professionals may recommend additional medicines to prevent infections in the clinic. These medicines can include antivirals, antibiotics against bacteria, antifungals, and vaccines. Especially if a patient undergoes a treatment that temporarily weakens the immune system. 
  • Vaccination is encouraged for all patients, even if they are not actively receiving treatment. Learn more here: 2024 Vaccination Guidelines for Cancer Patients.

What is IVIG?

IVIG, or intravenous immunoglobulin, is a supportive measure that some doctors prescribe when a patient’s immunoglobulin levels are low. It can also be referred to as immunoglobulin replacement therapy.

Immunoglobulins, also known as antibodies, are proteins that specifically recognize and bind to particular pathogens, such as bacteria or viruses, and help immune cells identify and eliminate them. 

A blood sample is required to find out if a patient has low immunoglobulin levels; that way, doctors can assess if a patient is eligible to receive an immunoglobulin infusion. 

Intravenous Immunoglobulin (IVIG) is a blood product prepared from the serum of multiple donors. It is mainly made of immunoglobulin G (IgG), and it provides a source of infection-fighting antibodies for CLL patients and helps them prevent serious infections. 

What Should I Expect From IVIG?  

The donor antibodies are administered intravenously (a needle into the vein). The infusion typically takes between 2-4 hours, depending on the prescribed dose. Patients are monitored at the care facility during the infusion. But it’s also possible to receive the infusion at home. You can talk with your doctor about your infusion options. 

People with CLL may only need IVIG once a month if they are actively undergoing treatment with venetoclax or a BTK inhibitor. People not actively undergoing treatment, such as those in watch and wait or individuals who have just finished treatment, may not need IVIG or be administered less frequently. Your health professional will help determine the best dosing schedule based on your needs. 

What Are the Side Effects of IVIG? 

Most people with CLL don’t have any side effects from IVIG. Possible side effects may include temporary headache and flu-like symptoms such as fever and chills (can last 24-48 hours after the infusion). To minimize these effects, healthcare providers might pre-medicate patients with antihistamines or acetaminophen. Slowing the rate of infusion can also help reduce side effects.

What IVIG Products Are Available? 

People with CLL usually receive the IVIG brand Gammagard. Other brands of IVIG include Privigen and Octagam. Differences between them include factors like the source of donors, the purification process, and the concentration. Patients may respond better to one brand over another.

IVIG Cost, Insurance Coverage, and Financial Support Resources

Insurance companies usually cover the cost of IVIG as long as it is medically necessary.

For people covered by Medicare, Medicare will pay 80% of the IVIG cost. The other 20% must be covered by a supplemental plan or by the patient. Under Part B, only the medicine cost is covered. Supplies and infusion pumps are not covered (see below financial resources to help cover any cost gaps). 

IVIG can cost between $5,000 and $10,000 per treatment without insurance. However, many financial resources can help reduce or waive costs and get you the medical help you need. 

Several of these financial support programs include: 

• Gammagard: Apply for financial assistance directly through the IVIG pharma company Takeda. 1-866-861-1750
• If you are receiving home infusions, speak with the home infusion company via their website or talk to your infusion nurse and/or case manager 
• NeedyMeds: Has an extensive database of patient assistance programs, state assistance, medicine discount programs, and free or low-cost medical care. They also help walk patients through the financial assistance process 
• IVIG Copay Assistance from AmeriPharma 866-634-1046
• The Assistance Fund: Helps patients and families facing high medical out-of-pocket costs by providing financial assistance for their copayments, coinsurance, deductibles, and other health-related expenses
• Accessia Health: They specialize in health insurance premiums, pharmacy co-payment, and co-payment waiver assistance 
• Partnership for Prescription Assistance: Connects pharma companies, healthcare providers, patient advocacy organizations, and community groups to help qualifying patients who are uninsured or underinsured to get free or nearly free medicines through a public or private program that is right for them
• Patient Advocate Foundation: Provides medicine financial aid funds and copay assistance 
• Good Days - Offers medicine, financial assistance, premium assistance, and travel assistance
• Healthwell Foundation: Helps patients cover the gap between what insurance does not cover related to copayments, deductibles, and health insurance premiums
• RxAssist: Helps provide free or affordable medicines and co-pay assistance
• RxHope: Helps with the financial assistance application process 
• RxOutreach: A mail-order pharmacy for people with little to no health insurance coverage 
• QuickRX IVIG Copay Assistance Program: Works with various organizations and manufacturer assistance programs to help make a patient’s medication affordable.

We want you to get the best treatments you can to help support your quality of life. Difficult side effects like increased risk of infection can be prevented with supportive measures like IVIG. Know your options and talk with your doctor about your immunoglobulin levels. If they are low, review the possibility of getting an IVIG prescription to prevent potentially severe infections. 

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Sources: 

• Intravenous Immunoglobulin (IVIG)
• Patient education: Intravenous immune globulin (IVIG) (Beyond the Basics)