Effectiveness of Prophylactic IVIG in Reducing Infections in Pediatric with Acute Lymphoid Leukemia After Therapy Discontinuation

Background Acute lymphoblastic leukemia is the most common malignant disease in children, and chemotherapy-induced immunosuppression leaves these patients highly vulnerable to infections. Secondary hypogammaglobulinemia is a common complication. Prophylactic IVIG has been proposed to lower infection rates, but its benefit in ALL survivors remains uncertain. This study assessed the impact of IVIG on infection outcomes after treatment completion. Methods This retrospective cohort included 305 children with ALL (ages 1–18 years) treated between March 2019 and October 2022. Patients were grouped by serum IgG levels (normal vs. low) and IVIG treatment (400 mg/kg per cycle). Outcomes over six months included febrile illness, infections, hospitalizations, and IVIG-related adverse effects. Statistical methods included chi-square, t-test, and univariate logistic regression. Results Of 305 patients, 200 had normal IgG and 105 had low IgG; 100 received IVIG. The mean age was 7.3 ± 3.5 years, and 54.1% were female. Febrile illness occurred in 40% of IVIG recipients compared with 34.1% of non-recipients (P = 0.770). A modest reduction in upper respiratory infections was seen in the IVIG group (20% vs. 26%, P = 0.087). No differences were found in hospitalization rates or serious infections. IVIG-related adverse effects included headache (10%), anaphylaxis (5%), and nausea/vomiting (5%). Logistic regression revealed no significant predictors of febrile illness. Conclusions Prophylactic IVIG did not significantly lower infection or hospitalization rates in children with ALL after therapy discontinuation, regardless of IgG status. Given the costs and potential adverse effects, routine use is not warranted. Larger multicenter studies are needed.