Guido Lancman, MD, on Next Steps for a Study of IVIG in Patients with Multiple Myeloma Receiving Daratumumab

Hypogammaglobulinemia was found to be nearly universal for patients with multiple myeloma during treatment with daratumumab, suggesting a role for intravenous immunoglobulin.

An assessment of patients with multiple myeloma receiving daratumumab (Darzalex) found that hypogammaglobulinemia was common and had significant potential to lead to infections suggesting a role for intravenous immunoglobulin (IVIG), especially in patients with recurrent infections.

These results, presented at the 2020 American Society of Hematology Annual Meeting & Exposition, were highly significant despite the small cohort studied. In addition, the case-crossover design employed allowed each patient to serve as an internal control.

In an interview with CancerNetwork®, Guido Lancman, MD, hematology and oncology fellow at the Icahn School of Medicine at Mount Sinai, discussed the next steps for the study.


We’re going to be looking at a few things. We want to see if there’s a specific IgG cutoff that predisposes [patients] to a higher risk of infections and to see if these patients might be more likely to benefit from IVIG. We’re going to look at whether the total amount of IVIG received actually decreases infections further. We’re also going to look at the role of neutropenia and lymphopenia, both by the number of infections and severity of infections. And I think lastly, what we’re going to do is find a control group of representative [daratumumab] patients that did not receive IVIG at our institution to see what their baseline rates of infection [hypogammaglobulinemia] are [so as to determine] how different our population is from a general [daratumumab] population.


Lancman G, Sastow D, Aslanova M, et al. Effect of intravenous immunoglobulin on infections in multiple myeloma (MM) patients receiving daratumumab. Blood. 2020;134(suppl 1):3131. Abstract 1404. doi:10.1182/blood-2019-127247