Document Detail


Some but not all benefits of intravenous immunoglobulin therapy after marrow transplantation appear to correlate with IgG trough levels.
MedLine Citation:
PMID:  1655138     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Multiple benefits of intravenous immunoglobulin (IVIG) therapy after marrow transplantation have been reported, including decreased incidence of acute graft-versus-host disease (GVHD), infection, sepsis, cytomegalovirus (CMV) pneumonitis and platelet use. To test the hypothesis that the observed beneficial effects of IVIG are related to the serum IgG levels achieved, we followed IgG levels (pre-infusion, 1 h and 24 h post-infusion) in 45 consecutive marrow transplant recipients. IVIG 500 mg/kg was given weekly for six doses starting day -8 pre-transplant, then every other week for a total of 11 doses. Forty-one patients (22 allogeneic, 17 autologous, two syngeneic) were evaluable. Patients with acute GVHD had significantly lower serum IgG trough levels (less than 1200 mg/dl) noted at day +20 post-transplant and afterwards than patients without GVHD (greater than or equal to 1200 mg/dl). Pharmacokinetic modeling of the data indicates that IgG half-life between day -8 and day +6 may predict which recipients are at increased risk of acute GVHD. Allogeneic recipients in the group with trough levels less than 1200 mg/dl required more platelet transfusions. Although there was no significant difference in fungal infection rates or bacteremia, sepsis was noted in only two recipients (one allogeneic, one autologous), both with serum IgG trough levels less than 1200 mg/dl. In addition, three allogeneic recipients had cytomegalovirus pneumonitis, all in the group with lower IgG trough levels. Thus, while serum IgG trough levels less than 1200 mg/dl appear to be strongly associated with acute GVHD, low levels may also be associated with increased platelet utilization, with cytomegalovirus pneumonitis, and sepsis, but not with the overall incidence of infection.
Authors:
M Cottler-Fox; M Lynch; L W Pickle; R Cahill; T R Spitzer; H J Deeg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Bone marrow transplantation     Volume:  8     ISSN:  0268-3369     ISO Abbreviation:  Bone Marrow Transplant.     Publication Date:  1991 Jul 
Date Detail:
Created Date:  1991-11-01     Completed Date:  1991-11-01     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8702459     Medline TA:  Bone Marrow Transplant     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  IM    
Affiliation:
V.T. Lombardi Cancer Center, Georgetown University Hospital, Washington, DC.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Bacterial Infections / epidemiology,  prevention & control
Bone Marrow Transplantation*
Child
Child, Preschool
Cytomegalovirus Infections / epidemiology,  prevention & control
Graft vs Host Disease / epidemiology,  prevention & control
Humans
Immunoglobulin G / analysis*
Immunoglobulins, Intravenous / adverse effects,  therapeutic use*
Incidence
Middle Aged
Mycoses / epidemiology,  prevention & control
Pulmonary Fibrosis / epidemiology,  prevention & control
Grant Support
ID/Acronym/Agency:
CA14626/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Immunoglobulin G; 0/Immunoglobulins, Intravenous

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