Klaesson S, Ringdén O, Ljungman P, Aschan J, Hägglund H, Winiarski J
Bone Marrow Transplantation Unit, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Transplantation. 1995 Dec 15;60(11):1225-30.
Forty-five recipients of bone marrow from HLA-identical siblings were given intravenous immune globulin (IVIG) 0.5 g/kg once a week during the first 3 months after transplantation. Fifty-three consecutive previously transplanted HLA-identical siblings were included as controls. Only patients who were cytomegalovirus (CMV) seropositive or had a CMV-seropositive donor were included. There were no major differences in patient characteristics between the two groups. However, more patients in the IVIG group received individualized graft-versus-host disease (GVHD) prophylaxis with less cyclosporine (P < 0.01), more controls received liposomal amphotericin B (P = 0.01), and more patients in the IVIG group received low-dose heparin as prophylaxis against veno-occlusive disease of the liver (P < 0.001). Median follow-up was 21 months in the IVIG group and 47 months in the control group. There were no differences between the groups with regard to time to engraftment, hospitalization time, or days with fever. No differences between the IVIG group and control group were detected in the incidence of acute GVHD grade II-IV (17% vs. 23%) or chronic GVHD (30% vs. 42%). The incidence of bacterial septicemias (53% vs. 63%) and invasive fungal infections (9% vs. 6%) was unaffected by IVIG treatment. The incidence of symptomatic CMV infection was the same in the two groups (14% vs. 16%). One control patient died of CMV interstitial pneumonitis, and 1 patient from each group died from viral interstitial pneumonitis of other origin. The incidence of veno-occlusive disease (VOD) was 16% in the IVIG group versus 6% in the controls (P = NS). Fatal VOD occurred in 11% of the IVIG group compared with none of the controls (P = 0.02). Other transplant-related complications did not differ between the two groups. Two-year survival was 62% in the IVIG group and 60% in the controls (P = NS). No significant beneficial effect was seen with IVIG, which may increase mortality in VOD. The use of high dose IVIG as prophylaxis in marrow transplant recipients is questioned.
45名接受来自 HLA 相同同胞的骨髓移植患者在移植后的前3个月内，每周静脉注射一次免疫球蛋白（IVIG），剂量为0.5 g/kg。53名连续的曾接受移植的 HLA 相同同胞作为对照。仅纳入巨细胞病毒（CMV）血清学阳性或有 CMV 血清学阳性供者的患者。两组患者的特征无重大差异。然而，IVIG 组更多患者接受了个体化的移植物抗宿主病（GVHD）预防，环孢素用量较少（P < 0.01），更多对照组患者接受了脂质体两性霉素 B（P = 0.01），IVIG 组更多患者接受低剂量肝素预防肝静脉闭塞病（P < 0.001）。IVIG 组的中位随访时间为21个月，对照组为47个月。两组在植入时间、住院时间或发热天数方面无差异。IVIG 组和对照组在 II-IV 级急性 GVHD（17% 对 23%）或慢性 GVHD（30% 对 42%）的发生率上未检测到差异。IVIG 治疗对细菌性败血症（53% 对 63%）和侵袭性真菌感染（9% 对 6%）的发生率无影响。两组有症状 CMV 感染发生率相同（14% 对 16%）。一名对照患者死于 CMV 间质性肺炎，每组各有一名患者死于其他原因的病毒性间质性肺炎。IVIG 组肝静脉闭塞病（VOD）发生率为16%，对照组为6%（P = 无显著性差异）。IVIG 组11% 发生致命性 VOD，而对照组无（P = 0.02）。两组其他与移植相关的并发症无差异。IVIG 组两年生存率为62%，对照组为60%（P = 无显著性差异）。未观察到 IVIG 有显著有益效果，其可能增加 VOD 的死亡率。对在骨髓移植受者中使用高剂量 IVIG 作为预防措施提出质疑。
