소아 조혈모세포이식 환자의 Intravenous Immunoglobulin 투여 스케줄 변경의 적절성 평가
Evaluation of Appropriateness of Changing Intravenous Immunoglobulin Administration Schedule in Pediatric Recipients of Hematopoietic Stem Cell Transplantation
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Background : After hematopoietic stem cell transplantation (HSCT), intravenous immunoglobulin (IVIG) is administered for prophylactic purposes at a high risk of infection due to decreased ability to produce antibodies. In this study, we evaluated that the appropriateness of schedule changes of the start time of IVIG administration from 7 to 21 days after HSCT by comparing the incidence rate, microorganisms and the number of occurrence of infection and analyzing risk factors. Methods : We enrolled pediatric patients with HSCT at Seoul St. Mary’s Hospital January 2018 to April 2020. We divided the patients into two groups based on administration schedule of IVIG. The IVIG 21 group included recipients who started IVIG administration on day 21 and IVIG 7 group included those who started IVIG administration on the day 7 after the transplantation. Results : There were no significant difference in the incidence and frequency of microbiological and clinical infections identified within three months of the observation period in the two groups. However, the microbiological infection within one month of transplantation was significantly different in the IVIG 7 group and IVIG 21 group, 78.7% vs 40.0% (p=0.001) and the number of occurrences (Mean±SD) 1.15±0.834 vs 0.51±0.702 (p=0.003), respectively. In the analysis of risk factors related to infection after transplantation, the pre-graft Immunoglobulin G (IgG) level was a significant factor. The lower the pre-graft IgG level, the higher the incidence of infectious complications (p=0.030, Odds ratio 0.997, 95% CI 0.995-1.000). Conclusion : Therefore, changing the IVIG first administration schedule from 7 days to 21 days after transplantation is effective in preventing complications of infection and it might have a cost-saving effect within the early period. However, considering that the number of subjects was small and the study was conducted during a short observation period, long-term follow-up studies with more patients are required.
Abstract
Background : After hematopoietic stem cell transplantation (HSCT), intravenous immunoglobulin (IVIG) is administered for prophylactic purposes at a high risk of infection due to decreased ability to produce antibodies. In this study, we evaluated that the appropriateness of schedule changes of the start time of IVIG administration from 7 to 21 days after HSCT by comparing the incidence rate, microorganisms and the number of occurrence of infection and analyzing risk factors. Methods : We enrolled pediatric patients with HSCT at Seoul St. Mary’s Hospital January 2018 to April 2020. We divided the patients into two groups based on administration schedule of IVIG. The IVIG 21 group included recipients who started IVIG administration on day 21 and IVIG 7 group included those who started IVIG administration on the day 7 after the transplantation. Results : There were no significant difference in the incidence and frequency of microbiological and clinical infections identified within three months of the observation period in the two groups. However, the microbiological infection within one month of transplantation was significantly different in the IVIG 7 group and IVIG 21 group, 78.7% vs 40.0% (p=0.001) and the number of occurrences (Mean±SD) 1.15±0.834 vs 0.51±0.702 (p=0.003), respectively. In the analysis of risk factors related to infection after transplantation, the pre-graft Immunoglobulin G (IgG) level was a significant factor. The lower the pre-graft IgG level, the higher the incidence of infectious complications (p=0.030, Odds ratio 0.997, 95% CI 0.995-1.000). Conclusion : Therefore, changing the IVIG first administration schedule from 7 days to 21 days after transplantation is effective in preventing complications of infection and it might have a cost-saving effect within the early period. However, considering that the number of subjects was small and the study was conducted during a short observation period, long-term follow-up studies with more patients are required.
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