Dr Furman ? about IVIG and enlarged spleen

[Guest guest]

Dear Dr. Furman, i did an IVIG infusion late March, the first of any tx

other than steroids for AIHA. The IVIG raised my hmg to 11.5 over an 8

week period but in the last two weeks my spleen has enlarged from 4cm to

6-7cm. My platelets are dropping below normal to 138 last week so it

appears the spleen is capturing them.

Do you know of anything that would be making the spleen enlarge? My

markers for hemolysis are in the normal range. Can a very very slow

hemolysis (that's not showing in numbers) be causing that big a change in

the spleen? Have you seen this happen after IVIG? And if so, why?

My doc wants to do another IVIG instead of starting Rituxan because my

hemolysis responded so well to it. My only concern with that would be if

the IVIG somehow caused the enlarged spleen. This is getting so complex

in my mind, i can hardly form the questions. Can IVIG also reduce the

spleen if this is a very slow hemolysis effect and not caused by IVIG

itself?

And the big unanswerable: how do we know what's going on? Thanks so

much. Carol

[Guest guest]

Carol,

IViG is an excellent stop gap measure for low platelets. It has the

added advantage of some infection protection, but it does nothing for

the underlying auto immune process, which is following it own course.

In my experience with ITP, when my cancer got worse, but ITP got

worse. Rituxan would probably help both the CLL and the AIHA, but

there is no guarantee for either. If it helps either, the spleen

should shrink. IVIG had no effect on my spleen. If the AIHA is less

active, you might expect the spleen to shrink a bit.

Hope that helps

, 56 yr family doc & father of 4, dx 9/05 del 11q w ATM,

unmutated, CD38+, W & W, stable except for growing nodes and spleen

until ITP 9/06 eventually failed steroids, IVIG , Rituxan and

splenectomy now on cyclosporin and finished Rituxan with ITP

controlled and CLL in old school CR, planning a RIC MUD HSCT July 1

see http://bkoffman.blogspot.com/

[Guest guest]

Carol,

There are many factors that might be in play here. IV Ig should not

increase your spleen size. You are correct in thinking the the

slight decrease in platelets are the result of them being trapped in

the enlarging spleen. The enlarging spleen has to be seen as

possible progression of the CLL. It should be evaluated further.

Several important questions include: how well established was the

diagnosis of AIHA? over what period has the spleen increased in

size? other symptoms? All of these questions should be taken into

account when considering the next step.

Rick Furman, MD

>

> Dear Dr. Furman, i did an IVIG infusion late March, the first of

any tx

> other than steroids for AIHA. The IVIG raised my hmg to 11.5 over

an 8

> week period but in the last two weeks my spleen has enlarged from

4cm to

> 6-7cm. My platelets are dropping below normal to 138 last week so

it

> appears the spleen is capturing them.

>

> Do you know of anything that would be making the spleen enlarge? My

> markers for hemolysis are in the normal range. Can a very very slow

> hemolysis (that's not showing in numbers) be causing that big a

change in

> the spleen? Have you seen this happen after IVIG? And if so, why?

>

> My doc wants to do another IVIG instead of starting Rituxan because

my

> hemolysis responded so well to it. My only concern with that would

be if

> the IVIG somehow caused the enlarged spleen. This is getting so

complex

> in my mind, i can hardly form the questions. Can IVIG also reduce

the

> spleen if this is a very slow hemolysis effect and not caused by

IVIG

> itself?

>

> And the big unanswerable: how do we know what's going on? Thanks

so

> much. Carol

>