Management of Hypogammaglobulinemia in Patients on Calquence

Monitoring and Replacement Therapy

The American College of Physicians recommends measuring baseline IgG levels in all patients prior to initiating Calquence, and considering baseline pneumococcal vaccine response testing if IgG levels are borderline (400-500 mg/dL) to assess functional antibody production 1
The Infectious Diseases Society of America suggests checking IgG trough levels every 3 months during the first year of Calquence therapy, then every 6 months if stable, and assessing infection frequency and severity at each visit 1, 2
The European Society for Medical Oncology recommends initiating IVIG if IgG levels are <400 mg/dL, or if there are ≥2 severe recurrent infections by encapsulated bacteria per year, regardless of IgG level 1, 3

The American Academy of Allergy, Asthma, and Immunology recommends an initial IVIG dose of 0.4 g/kg body weight every 3-4 weeks, with a target trough IgG level of 500-800 mg/dL 1, 2
The National Comprehensive Cancer Network suggests continuing monthly IVIG for the duration of Calquence therapy if IgG remains <400 mg/dL or recurrent infections persist, and monitoring for recovery of endogenous IgG production by keeping IVIG dose constant and watching for rising trough levels over time 1, 3

The Infectious Diseases Society of America recommends using aggressive and prolonged antimicrobial therapy for active infections, and considering prophylactic antimicrobials for patients with Grade 3/4 lymphopenia or history of opportunistic infections 2, 4
The American College of Physicians suggests continuing Calquence during IVIG treatment unless severe neutropenia or life-threatening infection develops, and withholding Calquence temporarily for Grade 3/4 infections until clinical resolution 4