Chronic hypogammaglobulinemia after allogeneic stem cell transplantation and their treatment with subcutanaeos inmunoglobulin in pediatric patients Hipogammaglobulinemia crónica postrasplante de precursores hematopoyéticos y su tratamiento con gammaglobulina subcutánea en pacientes pediátricos
Serra Font, Sara (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
López-Granados, Lucía (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Sisinni, Luisa (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Serna Berna, José (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Martinez-Martinez, Laura (Institut d'Investigació Biomèdica Sant Pau)
Fernández de Gamarra Martínez, Edurne (Institut d'Investigació Biomèdica Sant Pau)
de la Calle-Martín, Oscar (Institut d'Investigació Biomèdica Sant Pau)
Badell Serra, Isabel (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	Hypogammaglobulinemia in the first months after allogeneic hematopoietic stem cell transplantation (HSCT) is common in pediatric patients. During this phase, replacement therapy with human immunoglobulin must be administered parenterally to prevent infections. In some cases, this hypogammaglobulinemia persists over time, which forces further treatment when the patient is usually no longer a carrier of a central line, making them ideal candidates for subcutaneous replacement therapy. There is little published literature describing the use of this method in pediatric patients undergoing HSCT, widely described in replacement treatment in children with primary immunodeficiencies with very good results. An observational, descriptive, longitudinal and retrospective study is carried out. During the years 2008-2019, we evaluated all pediatric patients undergoing HSCT in our center with persistent chronic hypogammaglobulinemia (for over a year). The treatment phase with intravenous immunoglobulin (Privigen®) and the first four years of treatment with subcutaneous immunoglobulin (Hizentra®) are evaluated using a questionnaire. During the years 2008-2019, 175 patients underwent HSCT, 143 (82%) of whom exceeded three months after transplantation. 3 (2%) of them had persistent hypogammaglobulinemia. All three share factors described in the literature involved in immune reconstitution. After analyzing the questionnaire, it is observed that switching from intravenous to subcutaneous gammaglobulin has involved a great improvement in their quality of life. The origin of chronic hypogammaglobulinemia in our patients shows different factors and cannot be attributed to a single cause. Due to the limited number of patients no conclusions can be drawn at the population level. We have been able to observe that replacement treatment with Hizentra® 20% has been as effective as the intravenous administration without evidence of an increase in bacterial infections. Furthermore, it has also led to an improvement in quality of life and increased comfort, as the patients themselves have stated.
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Llengua:	Castellà
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic stem cell transplantation ; Childhood ; Hipogammaglobulinemia secundaria ; Immunoglobulin replacement therapy ; Infancia ; Inmunoglobulina subcutánea ; Secondary hypogammaglobulinemia ; Subcutaneous immunoglobulins ; Trasplante alogénico de precursores hematopoyéticos ; Tratamiento sustitutivo con inmunoglobulina
Publicat a:	Anales de pediatría, Vol. 97 Núm. 2 (agosto 2022) , p. 103-111, ISSN 1695-9531

DOI: 10.1016/j.anpedi.2021.08.011
PMID: 35869014

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