Fig. 3. Framework for initiating and managing IgG-RT in MM.

Review of both PI and hematologic malignancy literature supports the importance of obtaining baseline immune evaluation prior to immunosuppressive treatment and patients receiving immunosuppressive treatment should be monitored for HG. Initiation of IgG-RT can be considered depending on the severity of infections, IgG level, and immune function. A regularly scheduled and titrated dosing regimen has shown the best evidence for reducing severe bacterial infections. The IgG trough should be monitored closely and titrating to a biological trough can be considered. Safety labs and side-effects should also be regularly monitored. Various decision and monitoring strategies exist when deciding to discontinue IgG-RT.