Morell A, Barandun S
Institute for Clinical and Experimental Cancer Research, University of Berne, Switzerland.
Pediatr Infect Dis J. 1988 May;7(5 Suppl):S87-91.
Failure of host defense systems associated with malignancies may be attributable to the tumor, to cytoreductive therapy or to combined endogenous and iatrogenic influences. Management of the resulting increased susceptibility to infections may require supplementation of antibiotic therapy with additional forms of treatment, including passive immunization with antibodies. This review discusses the use of immunoglobulin preparations for intravenous administration (IVIG) in patients with secondary immunodeficiencies associated with neoplasia. A suitable model for evaluating the prophylactic effect of IVIG is chronic lymphocytic leukemia. Many observations suggest that IVIG reduces the frequency of acute respiratory infections. Another malignant condition with decreased serum levels of polyclonal immunoglobulins and high frequency of infections is multiple myeloma. A crossover study recently demonstrated that IVIG significantly (P less than 0.01) reduced the frequency of respiratory tract infections in these patients. Furthermore the prophylactic effect of IVIG was evaluated in patients with small cell carcinoma of the lung. In a randomized prospective trial it was noticed that IVIG applied during intensive chemotherapy and irradiation courses significantly (P = 0.04) reduced the frequency of infections. Evidence for a therapeutic effect of IVIG was obtained in adult tumor patients and in children with leukemia or non-Hodgkin's lymphoma who developed severe varicella-zoster virus infections. The treatment effectively controlled fever, skin lesions and neuralgia and prevented progression of the infection. Therapeutic usefulness of IVIG in bacterial infections is still based on anecdotal evidence. Experimental data suggest that in addition to effects mediated by specific antibodies, nonspecific interactions of IgG molecules with Fc-receptors on macrophages may be clinically important.
与恶性肿瘤相关的宿主防御系统功能衰竭可能归因于肿瘤、细胞减灭疗法或内源性和医源性影响的综合作用。对于由此导致的感染易感性增加的处理，可能需要在抗生素治疗的基础上补充其他治疗形式，包括抗体被动免疫。本综述讨论了静脉注射免疫球蛋白制剂（IVIG）在与肿瘤相关的继发性免疫缺陷患者中的应用。慢性淋巴细胞白血病是评估IVIG预防效果的合适模型。许多观察结果表明，IVIG可降低急性呼吸道感染的频率。另一种血清多克隆免疫球蛋白水平降低且感染频率高的恶性疾病是多发性骨髓瘤。最近一项交叉研究表明，IVIG可显著（P<0.01）降低这些患者呼吸道感染的频率。此外，还对肺癌小细胞癌患者的IVIG预防效果进行了评估。在一项随机前瞻性试验中发现，在强化化疗和放疗期间应用IVIG可显著（P = 0.04）降低感染频率。在成年肿瘤患者以及患有白血病或非霍奇金淋巴瘤且发生严重水痘-带状疱疹病毒感染的儿童中，获得了IVIG具有治疗效果的证据。该治疗有效控制了发热、皮肤病变和神经痛，并预防了感染的进展。IVIG在细菌感染中的治疗作用仍基于轶事证据。实验数据表明，除了特异性抗体介导的作用外，IgG分子与巨噬细胞上Fc受体的非特异性相互作用可能在临床上具有重要意义。
