[CIS-PAGID] IVIG replacement according to body weight?

[Church, Joseph]

Bodo:  This reference will add to the list of publications that I use to "discuss" IVIG dosing with insurance payors.  JC

-----Original Message-----
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 3:54 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] IVIG replacement according to body weight?

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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