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

[Berger, Melvin]

Interesting, but not really surprising given the fact that the mean IgG level on treatment (8.4) is less than 2 times the pretreatment (baseline) mean IgG level (4.3).  I my opinion, studies like this should look at the increment above baseline, not the trough per se.  An interesting point is that in every graph, patients receiving doses every 4th week are mostly below the apparent median of the x-axis parameter. 
 
Melvin Berger, M.D., Ph.D.
Adjunct Professor of Pediatrics and Pathology
Case Western Reserve University
Cleveland, OH 44106

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Grimbacher, Bodo
Sent: Fri 5/11/2012 6:40 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 attachmentS
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 thoughtsS..

>

>

>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

>

>

>

>

>

>








Visit us at www.UHhospitals.org.

The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
use of the addressee only. University Hospitals and its affiliates disclaim
any responsibility for unauthorized disclosure of this information to anyone
other than the addressee.

Federal and Ohio law protect patient medical information, including
psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
3701.243 prohibit disclosure of this information without the specific
written consent of the person to whom it pertains, or as otherwise permitted
by law.
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/ms-tnef
Size: 8827 bytes
Desc: not available
Url : <http://seven.pairlist.net/mailman/private/pagid/attachments/20120513/05adbafc/attachment-0001.bin>