• hypogammaglobulinemia;
  • childhood;
  • bone marrow transplantation;
  • immunoglobulin

Sundin M, Nordin K, Jostemyr Y, Winiarski J. Subcutaneous IgG replacement after pediatric SCT.

Abstract:  Hypogammaglobulinemia is common after pediatric SCT and IgG replacement is recommended. Some children will have a prolonged hypogammaglobulinemia but may have poor venous access which impedes further iv IgG replacement. In primary antibody deficiencies, sc IgG replacement, performed by parents at home, has been shown to be efficient and to improve life quality. In this study prolonged hypogammaglobulinemia post-SCT was observed in 58 of 158 (37%) children transplanted 2003–2010. Iv IgG (n = 46) and sc IgG (n = 12) replacement was compared and in 32 of 35 surviving children, it was possible to assess family attitudes to the treatment. There was no significant difference in numbers of patients reaching IgG ≥4 g/L (64–96%) or IgG trough levels between the two groups. However, the levels were less variable in the sc IgG group. Side effects associated with the IgG replacement occurred more frequently in the iv IgG group (67.4% vs. 16.7%, p = 0.003). The frequency of clinical infections was equal in the groups. No family in the sc IgG group desired change of route of administration in contrast to the iv IgG group. To conclude, sc IgG replacement is a convenient and safe alternative to iv IgG replacement which should be offered to children undergoing SCT.