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- Title
High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy. A study of the American Bone Marrow Transplant Group.
- Authors
Wolff, Steven N.; Fay, Joseph W.; Herzig, Roger H.; Greer, John P.; Dummer, Stephen; Brown, Randy A.; Collins, Robert H.; Stevens, Don A.; Herzig, Geoffrey P.; Wolff, S N; Fay, J W; Herzig, R H; Greer, J P; Dummer, S; Brown, R A; Collins, R H; Stevens, D A; Herzig, G P
- Abstract
<bold>Objective: </bold>To determine whether intravenous immunoglobulin (IVIG) prevents severe infections during autologous bone marrow transplantation or equivalent high-dose myelosuppressive therapy.<bold>Design: </bold>Randomized, stratified, nonblinded study.<bold>Setting: </bold>Three tertiary care university hospitals.<bold>Patients: </bold>One hundred seventy patients entered the study; 82 received IVIG and 88 were untreated controls. The study groups were similar for parameters capable of influencing the likelihood of infection.<bold>Interventions: </bold>Intravenous immunoglobulin was given weekly at a dose of 500 mg/kg body weight from the initiation of cytotoxic therapy to the resolution of neutropenia.<bold>Measurements: </bold>The development of bloodstream or other clinically proven infection, platelet use, and the development of alloimmunity to platelet transfusion.<bold>Results: </bold>Clinical infection, bacteremia, and fungemia occurred in 43%, 35%, and 6% of the IVIG-treated patients and in 44%, 34%, and 9% of the control patients. Gram-positive bacteremia and gram-negative bacteremia occurred in 28% and 11% of the IVIG group and in 23% and 13% of the control group. Death due to infection occurred in 4.9% of IVIG recipients and in 2.3% of controls. None of these observations was statistically significant (P > 0.2). Survival to hospital discharge was achieved in 86.6% of the IVIG group and in 96.6% of the control group. The survival difference (10%; 95% CI, 1.7% to 18.3%; P = 0.02) was due to a higher incidence of regimen-related toxic death in the IVIG-treated group.<bold>Conclusions: </bold>The use of IVIG did not prevent infection. Fewer deaths occurred among controls due to a higher incidence of fatal hepatic veno-occlusive disease in patients receiving IVIG.
- Subjects
THERAPEUTIC use of immunoglobulins; INTRAVENOUS therapy; TRANSPLANTATION of organs, tissues, etc.; BONE marrow
- Publication
Annals of Internal Medicine, 1993, Vol 118, Issue 12, p937
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-118-12-199306150-00004