[CIS-PAGID] IVIG replacement according to body weight?
Grimbacher, Bodo
b.grimbacher at ucl.ac.uk
Fri May 11 18:40:51 EDT 2012
Dear all,
were you aware of this paper?
see attachmentŠ
Yours, Bodo
Centre of Chronic Immunodeficiency
Director
79108 Freiburg, GERMANY
Am 11.05.12 23:28 schrieb "Nelson, Robert P Jr" unter <ronelson at iupui.edu>:
>Our health system, beginning with the pharmacy branch, is pondering the
>question of whether changing IVIG dosing guidelines from actual to ideal
>body weight
> would be low hanging fruit for reducing IVIG expenditures, without
>adversely affecting patient care outcomes. Of course the initial
>question is general and not answerable across an array of
>immunodeficiency/autoimmune/neurological conditions. But I thought
> this might be a good group to start with and ask if this strategy is
>being considered elsewhere or if you might have thoughtsŠ..
>
>
>You see, many Hoosiers are large and the savings would be significant.
>
>Bob
>
>
>Robert P. Nelson Jr., MD
>Professor of Medicine and Pediatrics
>Divisions of Hematology/Oncology
>535 Barnhill Dr. Ste 473
>Indianapolis, IN 46202
>Telephone: 317-948-1186
>E-mail:
>ronelson at iupui.edu
>pager: 317-312-1773
>
>
>From: pagid-bounces at list.clinimmsoc.org
>[mailto:pagid-bounces at list.clinimmsoc.org]
>On Behalf Of Nelson, Robert P Jr
>Sent: Friday, May 11, 2012 5:19 PM
>To: 'pagid at list.clinimmsoc.org'
>Subject: Re: [CIS-PAGID] non conditioned BMT in a SCIDs case
>
>
>
>Dr. Mageed,
>
>My opinion is that it is good enough, especially if the Hb and platelet
>counts are normal.
>
>To me, the function is adequate to immunize to live viruses.
>
>If the T cell numbers are stable rather than dropping, I would observe.
>I don¹t think it is important whether the myeloid cells are donor or
>recipient. What you gain with
> a boost is a minor lymphocyte nudge to 100%, if she is not there
>already, and risk graft-versus-host, which would subvert the goal of
>improving reconstitution. I don¹t think that the mixed lymphocyte
>chimerism is the predominate immunophysiological influence
> on the stalled recovery, so that the boost may not even provide the
>hoped for result with respect to increased naïve T cell production. The
>rather tepid production now may improve given more time and if the donor
>is a heterozygote for the unknown molecular
> defect, a boost would not be expected to help.
>
>Where are you getting your TRECs measured, just curious, looking for a
>resource.
>
>Bob
>
>
>
>
>Robert P. Nelson Jr., MD
>Professor of Medicine and Pediatrics
>Divisions of Hematology/Oncology
>535 Barnhill Dr. Ste 473
>Indianapolis, IN 46202
>Telephone: 317-948-1186
>E-mail:
>ronelson at iupui.edu
>pager: 317-312-1773
>
>
>From:pagid-bounces at list.clinimmsoc.org[mailto:pagid-bounces at list.clinimmso
>c.org]On Behalf Of Aly.Mageed at helendevoschildrens.org
>Sent: Friday, May 11, 2012 1:15 PM
>To: pagid at list.clinimmsoc.org
>Subject: Re: [CIS-PAGID] non conditioned BMT in a SCIDs case
>
>
>
>What does the group think of a 4YO with a SCIDs/Omenn¹s with an
>unidentified molecular basis who was transplanted from a full sib without
>conditioning more than 3 years ago? She is doing well
> clinically without serious/unusual infections. However, she has stalled
>in donor chimerism to only 10-14%, her lymphocytes are 96% donor (likely
>100% if it were very pure without myeloid contamination). Yet, she
>continues with CD3/4/8 lymphopenia (CD3 is 400-1000),
> mostly 400-500. Most recent CD4 were 250. CD4RTE 27%, TREC is low at
>280-350 (600-700/million CD3), CD19 last was 300. She is surprisingly
>maintaining her own IgG level 400-500. Despite the lymphopenia, PHA is
>good at 60-70% functionally. She responded well
> to non live vaccines with protective levels against Hep B, DPT and
>prevnar.
>So the Qs are:
>
>1.
>Is this good enough at this stage since she is clinically well?
>2.
>Could she get live vaccines?
>3.
>Or, Does she need a graft boost?....
>Thanks
>
>Aly Mageed, MD, MBA
>Pediatric Blood & Marrow Transplant
>Helen DeVos Children's Hospital
>aly.mageed at helendevoschildrens.org
>
>
>
>
>
>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: Khan S et al DrugMetabolismLett 2011.pdf
Type: application/pdf
Size: 242416 bytes
Desc: Khan S et al DrugMetabolismLett 2011.pdf
Url : <http://seven.pairlist.net/mailman/private/pagid/attachments/20120511/fd9c3437/attachment-0001.pdf>
More information about the PAGID
mailing list