Introduction

Secondary immunodeficiency is becoming a greater medical concern as the usage of immunosuppressive and biological treatments has increased. Individuals with certain medical conditions, such as hematological malignancies, can also have secondary immunodeficiency. Immunoglobulin replacement therapy (IGRT), which has been used for decades in inherited or primary immunodeficiency, provides some protection to patients with acquired and predominant antibody deficiency, i.e. secondary antibody deficiency (SAD). However, IGRT is costly, and supplies are limited. Although there are clinical guidelines on when to initiate IGRT, there is no guideline on when to discontinue it.

Areas covered

The authors reviewed existing literature and provided an overview of the current state of knowledge regarding IGRT discontinuation in SAD patients.

Expert opinion

Long-term supplementary immunoglobulin may not be necessary. Although it is possible to successfully transition away from IGRT in individuals with SAD, evidence-based practices are limited. Without clear guidelines and reliable prognostic markers, IGRT discontinuation practices are restricted to clinical judgment. For this reason, additional research should be conducted to identify markers that indicate the recovery of humoral immunity. Furthermore, the derivation and validation of a set of combined clinical and laboratory criteria to allow safe and timely IGRT discontinuation is warranted.

中文翻译：

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二级抗体缺乏症患者中止免疫球蛋白替代疗法

介绍

随着免疫抑制和生物治疗方法的使用增加，继发性免疫缺陷正在引起更大的医学关注。患有某些疾病（例如血液系统恶性肿瘤）的个体也可能患有继发性免疫缺陷。免疫球蛋白替代疗法（IGRT）已在遗传性或原发性免疫缺陷中使用了数十年，它为患有获得性和主要抗体缺乏症（即第二抗体缺乏症）的患者提供了一些保护。但是，IGRT成本高昂，而且供应有限。尽管有关于何时启动IGRT的临床指南，但没有关于何时终止IGRT的指南。

覆盖区域

作者回顾了现有文献，并概述了SAD患者中有关IGRT停药的当前知识状态。

专家意见

可能不需要长期补充免疫球蛋白。尽管有可能在SAD患者中成功地摆脱IGRT，但基于证据的做法仍然有限。没有明确的指导方针和可靠的预后指标，IGRT停药实践仅限于临床判断。因此，应进行更多研究以鉴定指示体液免疫恢复的标志物。此外，有必要推导和验证一套综合的临床和实验室标准，以允许安全，及时地终止IGRT。