[Immunoglobulin substitution in malignant lymphoma].

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.