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Immunization
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Michael F. Para, Susan L. Koletar, Carter L. Diggs
New techniques for separating gamma globulin from plasma which do not cause aggregation of antibodies have been developed more recently. These immunoglobulin preparations can be administered intravenously so that large volumes and high levels of antibodies can be given. In fact, physiologically normal levels of immunoglobulin can now be achieved in patients who completely lack the ability to generate their own antibodies.
Hemolytic Disease of the Fetus and Newborn
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Pedro Argoti, Ana M. Angarita, Giancarlo Mari
Pharmacology:The median half-life of Rh immunoglobulin is 21 days regardless of the route of administration (IM or IV). Peak serum levels (C max) are higher with IV versus IM administration (71 versus 22 ng/mL). Mean time taken to reach maximum concentration (T max) IV versus IM administration (1 versus 5.5 days) [38, 39]. A low maternal anti Rh (D) titer (typically <4) can be detected for several weeks after the administration of Rh immunoglobulin [38].
Erythroblastosis fetalis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Avinash Patil, Brian Brocato, Rebecca A. Uhlmann, Giancarlo Mari
Alloimmunization can infrequently occur prior to 28 weeks of gestation, leading to the recommendation that an antibody screen be performed at the time of immunoglobulin administration to detect preexisting maternal sensitization. One dose of Rh (D) immunoglobulin is effective for 12 weeks, with a half-life of 16 to 24 days, and should be re-dosed after that interval in antepartum patients. The anti-D immunoglobulin affects the antibody screen (38). Usually, the effect of the immunoglobulin is not present until 12 weeks after its administration.
Current therapies for chronic lymphocytic leukemia: risk and prophylaxis strategies for secondary/opportunistic infections
Published in Expert Review of Hematology, 2023
Lucia Diella, Davide Fiore Bavaro, Giacomo Loseto, Crescenza Pasciolla, Carla Minoia, Daniela Di Gennaro, Alessandra Belati, Maria Stella De Candia, Francesco Di Gennaro, Annalisa Saracino, Attilio Guarini
This condition depends on a reduced production of normal B cells in conjunction with the disruption of their regulatory cells. In addition, a low B cell response to cytokines, namely IL-2, is often found, which also contributes to hypogammaglobulinemia. The role of immunoglobulin replacement therapy in secondary immunodeficiency is still discussed. According to current literature, the administration of intravenous immunoglobulin is not cost-effective and is not associated with improvement of overall survival and quality of life; based on these data, intravenous immunoglobulin is reserved for CLL patients with hypogammaglobulinemia and recurrent bacterial infections, or with severe infections and serum IgG levels<400 mg/dL [16]. Subcutaneous immunoglobulin may be considered as a worthy alternative, due to lower incidence of adverse events, lower costs, and better quality of life, with similar efficacy [17], even in patients with impaired humoral response to peptide and polysaccharide vaccines [18].
Cost-effectiveness analysis of KTE-X19 CAR T therapy versus real-world standard of care in patients with relapsed/refractory mantle cell lymphoma post BTKi in England
Published in Journal of Medical Economics, 2022
Svenja Petersohn, Gilles Salles, Michael Wang, Jim Wu, Sally W. Wade, Claire L. Simons, Craig Bennison, Rubina Siddiqi, Weimin Peng, Ioana Kloos, Gab Castaigne, Georg Hess
AEs of grade 3 or 4 with an incidence of ≥5% based on the ZUMA-2 trial were modelled for KTE-X19 (see Supplementary Table 4, additional details on AEs in Supplementary Table 5). Additionally, cytokine release syndrome (CRS) of grade ≥2 (61.8% of patients) was modelled by assuming treatment with tocilizumab, CRS-related hospitalization in the ICU was assumed to be included in the ICU care component of KTE-X19 administration. AEs were costed in line with NHS reference costs34, hypogammaglobulinemia (20.6% of patients) was assumed to be treated with 0.5 g/kg of IV immunoglobulin every 4 weeks for 12 months, and BNF prices were applied33. Although AEs occurred with the individual SoC treatment components, limited safety data were identified from the literature and consequently, no AEs were modelled for SoC as a conservative assumption.
Therapeutic plasma exchange for myasthenia gravis, Guillain-Barre syndrome, and other immune-mediated neurological diseases, over a 40-year experience
Published in Expert Review of Neurotherapeutics, 2022
Mireya Fernández-Fournier, Ana Kerguelen, Francisco Javier Rodríguez de Rivera, Laura Lacruz, Santiago Jimeno, Itsaso Losantos, Dolores Hernández-Maraver, Inmaculada Puertas, Antonio Tallon-Barranco, Aurora Viejo, Ana Frank García, Exuperio Díez-Tejedor
Treatment costs associated with TPE and compared with immunoglobulins depend on how these are measured and on the different settings [17,18]. At our center, the treatment of neurological patients with TPE does not impact fixed costs (staff and machinery) due to patient volume. In this setting, treatment with TPE implies only the cost of replacement fluid albumin and disposable equipment used (currently 589 euros at our hospital per cycle), which is below regular costs of immunoglobulins (variable according to regulatory agreements and the law of supply and demand). Lately, scarcity of immunoglobulins has been a worldwide issue representing a potential threat to adequate patient treatment. All these aspects reinforce the convenience of ensuring good acquaintance of neurologists with TPE.