Wehmeier A
Medizinische Klinik und Poliklinik, Heinrich-Heine-Universität, Düsseldorf.
Infusionsther Transfusionsmed. 1993 Apr;20 Suppl 1:73-6; discussion 77.
Substitution with intravenously administered immunoglobulin seems to be indicated in lymphoma patients with acquired immunoglobulin deficiency, i.e., primarily patients with chronic lymphocytic leukemia and multiple myeloma. Infectious complications, mainly of the upper airways, are a major cause of morbidity and mortality in these patients. The immunoglobulin levels are correlated with stage of the disease, frequency of infections, and patient survival. Besides immunoglobulin deficiency, there are less well characterized defects of cellular immunity. Three prospective studies evaluating the effectiveness of immunoglobulin substitution in patients with chronic lymphocytic leukemia and myeloma have been published. A dose of 400 mg/kg or 10 g of immunoglobulin was administered intravenously every 3 or 4 weeks. A reduction of bacterial infections, but not of deaths due to infectious complications, was observed. The treatment was usually well tolerated with few side effects. However, to date it has not been established which patient subgroups really benefit from immunoglobulin therapy in terms of improvement of quality of life. Thus a general recommendation of immunoglobulin therapy in chronic lymphocytic leukemia and multiple myeloma can at present not be made.
对于获得性免疫球蛋白缺乏的淋巴瘤患者，即主要是慢性淋巴细胞白血病和多发性骨髓瘤患者，静脉注射免疫球蛋白替代治疗似乎是合适的。感染并发症，主要是上呼吸道感染，是这些患者发病和死亡的主要原因。免疫球蛋白水平与疾病分期、感染频率和患者生存率相关。除了免疫球蛋白缺乏外，细胞免疫缺陷的特征尚不明确。已经发表了三项评估免疫球蛋白替代治疗对慢性淋巴细胞白血病和骨髓瘤患者有效性的前瞻性研究。每3或4周静脉注射400mg/kg或10g免疫球蛋白。观察到细菌感染有所减少，但因感染并发症导致的死亡并未减少。该治疗通常耐受性良好，副作用很少。然而，迄今为止，尚未确定哪些患者亚组在改善生活质量方面真正从免疫球蛋白治疗中获益。因此，目前尚不能对慢性淋巴细胞白血病和多发性骨髓瘤患者普遍推荐免疫球蛋白治疗。
