[CIS-PAGID] IVIG replacement according to body weight?
Nelson, Robert P Jr
ronelson at iupui.edu
Fri May 11 18:53:35 EDT 2012
Bodo, thx very much. 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
-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Grimbacher, Bodo
Sent: Friday, May 11, 2012 6:41 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] IVIG replacement according to body weight?
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.clinim
>mso 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
>
>
>
>
>
>
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