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IMS 2026 | Hypogammaglobulinemia, infection risk, and IgG replacement therapy in myeloma
Wolfgang Willenbacher, MD, Medical University of Innsbruck, Innsbruck, Austria, discusses real-world data from the Austrian Myeloma Registry on hypogammaglobulinemia, infection risk, and immunoglobulin replacement therapy in patients with multiple myeloma. He highlights the increased infection risk associated with IgG levels below 500 mg/dL and the potential for replacement therapy to reduce infection-related hospitalizations, emphasizing proactive monitoring and prevention. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
Well, we did an analysis in the Austrian Myeloma Registry based on data from over a thousand patients and looked at infection risks, treatment, and the effect of immunoglobulin replacement therapy, be it IV or subcutaneously. And the data are quite clear. If you’re a severe hypogammaglobulinemic, defined as less than 500 milligrams per deciliter of IgG, you’re in trouble, and if you don’t substitute, infection risk quadruples...
Well, we did an analysis in the Austrian Myeloma Registry based on data from over a thousand patients and looked at infection risks, treatment, and the effect of immunoglobulin replacement therapy, be it IV or subcutaneously. And the data are quite clear. If you’re a severe hypogammaglobulinemic, defined as less than 500 milligrams per deciliter of IgG, you’re in trouble, and if you don’t substitute, infection risk quadruples. On the other side, we’ve seen, and this is true not only for the new immunotherapies, it’s also true for conventional myeloma treatments, that by replacement you can bring back that risk by three-quarters for hospitalizations, and there’s also a trend for decreased mortality. Given the great efficacy of our treatments, we should avoid losing patients to avoidable complications. Well, the practical approach is just to monitor your patients, and if they go down below 500, start preemptive substitution of immunoglobulins. That’s not everything. Naturally, you have to think about prophylaxis, on vaccinations, best of that before starting immunosuppressive therapies, on reducing steroid doses and patient education. They should come in if they have signs of infection.
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