BETA - What is hypogammglobilinemina?

A condition that commonly occurs in multiple myeloma patients is called hypogammaglobulinemia, just my favorite word to say since I've learned to say it, which is really just a fancy way to say that your IgG level or your immunoglobulin level G is low. So your IgG is one of your antibodies that's produced just naturally in your immune system and it makes up about 75 to 80% of your antibodies in your natural you know fighter cells that keep away bacterial infections. And so what can happen in multiple myeloma patients mainly because the plasma cells are not functioning the way they need to or because of chemotherapy treatment or radiation those levels can be affected and can be made low. So really what this means is that patients are at a greater risk for developing those bacterial or fungal infections and so signs and symptoms that we would you know typically see if someone were to have a low IgG level or hypogammaglobulinemia would be those infections. So typically infections present themselves initially with a fever you know your cough or sore throat you know really those abnormal I'm not feeling well symptoms could be associated with an infection. So that's kind of what we're looking out for if a patient were to have developed this hypogammaglobulinemia. Ways that we treat that is you know making sure that patients are having good oral hygiene, good general hygiene in general, making sure that you're washing your hands, staying away from sick people. And another way that we help this is administering IV IgG which is known as IV IgG. So intravenous IgG to help replace and give you a boost of those IgG levels with a goal to keep patients you know over about a value of 400. A typical value is you know around 700 to 15,000 so if you're getting down to 400 you're pretty low. So keeping it above that is going to help better patients especially in the realm of getting treatment for their multiple myeloma in which their regular plasma cells their immunity cells are being either suppressed or not functioning correctly because of their disease or the treatments that they're receiving. What is IV IgG? IV IgG is an infusion that we give to patients when their IgG level gets below that 400. So we will monitor the labs of a patient. It's very regular for your immunoglobulin levels to be checked with the traditional myeloma labs and if we notice that that's lower we will your team or your healthcare team would reach out to the patient and say hey that level is looking low we want to give you an infusion. They'll bring them into whatever sort of infusion center that they have specifically here at Mayo Clinic we bring them into our chemo unit or potentially our ambulatory infusion center. We start an IV or utilize whatever central line they may have whether that's a port, PICC line, what have you depending on where they're at in their treatment. We administer that through the IV it's relatively well managed and then maintained and you're monitored throughout the infusion it's disconnected and then the patient goes home. IV IgG is given every four weeks with a minimum of 25 days between each infusion and so we'll monitor that IgG level monthly and administer as needed as long as the patient is agreeable. Especially when patients are you know frequent travelers or have frequent infections it's even more important but it in different studies found that it's important to be administering IV IgG for patients who are getting treatment who have had CAR T who've had stem cell who are getting bispecific agents that were keeping that level high to prevent an infection rather than working on the back end to address it. IV IgG is an infusion that we give to patients what we do is we pull IV IgG from a whole bunch of different people it's compounded together and then administered like a transfusion to a patient in order to help boost that IgG level in their bloodstream.