Immunoglobulin (Ig) replacement therapy (IgRT) consists of the administration of low-dose human polyclonal Igs for the treatment of primary and secondary hypogammaglobulinemia that are associated with recurrent infections and immune dysfunction. IgRT restores physiological antibody levels and induces an immunomodulatory effect by strengthening immune effector cells, thus reducing infections. Here, we describe the pharmacology of different Ig formulations with a particular focus on their mechanism of action as low-dose IgRT, including the direct anti-microbial effect and the immunomodulatory function. In addition, we describe the use of therapeutic Igs for the management of multiple myeloma (MM), a hematologic malignancy characterized by severe secondary hypogammaglobulinemia associated with poor patient outcome. In MM settings, IgRT prevents life-threatening and recurrent infections showing promising results regarding patient survival and quality of life. Nevertheless, the clinical benefits of IgRT are still controversial. A deeper understanding of the immune-mediated effects of low-dose IgRT will provide the basis for novel combined therapeutic options and personalized therapy in MM and other conditions characterized by hypogammaglobulinemia.
免疫球蛋白（Ig）替代疗法（IgRT）是指通过给予低剂量人源多克隆免疫球蛋白，用于治疗与反复感染及免疫功能失调相关的原发性和继发性低丙种球蛋白血症。该疗法通过增强免疫效应细胞，恢复生理性抗体水平并诱导免疫调节作用，从而减少感染发生。本文系统阐述了不同免疫球蛋白制剂的药理学特性，特别聚焦于其作为低剂量IgRT的作用机制，包括直接抗微生物效应与免疫调节功能。此外，我们还探讨了治疗性免疫球蛋白在多发性骨髓瘤（MM）管理中的应用——这是一种以严重继发性低丙种球蛋白血症为特征、与患者不良预后相关的血液系统恶性肿瘤。在MM治疗中，IgRT能有效预防危及生命的反复感染，在改善患者生存率和生活质量方面展现出良好前景。然而，IgRT的临床获益仍存在争议。深入理解低剂量IgRT的免疫介导效应，将为MM及其他低丙种球蛋白血症相关疾病的新型联合治疗方案及个体化治疗策略提供理论基础。
Immunoglobulin Replacement Therapy: Insights into Multiple Myeloma Management
肿瘤(癌症)患者之家