[Use of a polyvalent intravenous immunoglobulin or specific cytomegalovirus hyperimmunoglobulin for modification of cytomegalovirus infections and prevention of interstitial pneumonias following bone marrow transplantation]

Abstract

The effects of prophylactic, polyvalent intravenous immune globulin on cytomegalovirus infection and interstitial pneumonia in allogenic marrow transplants were evaluated in an ongoing, randomized controlled trial. Thirty-eight patients were given weekly doses (20 cc/kg) of polyvalent intravenous immune globulin before and after transplantation, and 37 patients were controls. Both symptomatic cytomegalovirus infection (17 of 37 or 46% vs. 8 of 38 or 21%, p = 0.04) and interstitial pneumonia (17 of 37 or 46% vs. 7 of 38 or 18%, p = 0.02) occurred less frequently in the recipients of polyvalent intravenous immune globulin. In separate kinetic studies, a 5 cc/kg dose of a cytomegalovirus-specific hyperimmune globulin produced cytomegalovirus antibody titers in patients equivalent to those achieved after the 20 cc/kg dose of polyvalent intravenous immune globulin. All immune globulin preparations were well-tolerated. These preliminary results suggest that intravenous immune globulin can modify the severity of cytomegalovirus infection and prevent interstitial pneumonia in marrow transplants. Additional trials are now needed to define the minimal effective dose of intravenous immune globulin and to compare the effectiveness of different intravenous immune globulin formulations.