Sullivan K M
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
Clin Exp Immunol. 1996 May;104 Suppl 1:43-8.
Intravenous immune globulin (IVIG) has been used with success to prevent and treat infection in patients with immunodeficiencies of humoral immune function. More recently, IVIG has been shown to modulate immune responses and to treat successfully several autoimmune disease. Initial trials in bone marrow transplant recipients were aimed at the prevention of cytomegalovirus (CMV) disease. Although most studies showed such a benefit, CMV prophylaxis is now commonly provided by use of CMV-negative blood products or ganciclovir prophylaxis in, respectively, CMV-seronegative and CMV-seropositive patients. Acute and chronic graft-versus-host disease (GVHD) and associated infections remain critical barriers to the wider application of allogeneic blood or marrow transplantation, especially among patients given HLA-disparate grafts. To date, four controlled clinical trials have shown a significant reduction in acute GVHD in patients given IVIG (500-1000 mg/kg) weekly until 90-120 days post-transplant. In addition, bacterial infection in the early transplant period appears reduced. Meta-analysis of controlled trials reporting acute GVHD endpoints in 379 patients found a relative risk of acute GVHD of 0.68 (95% CI, 0.45-1.02) in IVIG recipients compared to untreated controls. Overall mortality reported in 809 patients in these trials showed an odds ratio of mortality of 0.74 (0.55-0.99) in IVIG recipients compared to controls (values < 1.0 suggest that IVIG was effective in preventing the event). More recently it has been shown that in the absence of hypogammaglobulinaemia, IVIG (500 mg/kg) given monthly from day 90 to 360 did not reduce the incidence of chronic GVHD or late complications. Future research is aimed at characterizing the mechanism of action of suppression of acute GVHD with weekly IVIG prophylaxis and the role of IVIG prophylaxis in patients receiving unrelated marrow grafts.
静脉注射免疫球蛋白（IVIG）已成功用于预防和治疗体液免疫功能免疫缺陷患者的感染。最近，IVIG已被证明可调节免疫反应，并成功治疗多种自身免疫性疾病。在骨髓移植受者中进行的初步试验旨在预防巨细胞病毒（CMV）疾病。尽管大多数研究显示了这种益处，但现在通常分别通过使用CMV阴性血液制品或更昔洛韦预防措施，对CMV血清阴性和CMV血清阳性患者进行CMV预防。急性和慢性移植物抗宿主病（GVHD）及相关感染仍然是同种异体血液或骨髓移植更广泛应用的关键障碍，尤其是在接受HLA不相合移植物的患者中。迄今为止，四项对照临床试验表明，在移植后90 - 120天内每周给予IVIG（500 - 1000 mg/kg）的患者，急性GVHD显著减少。此外，移植早期的细菌感染似乎也有所减少。对报告379例患者急性GVHD终点的对照试验进行的荟萃分析发现，与未治疗的对照组相比，接受IVIG治疗的患者急性GVHD的相对风险为0.68（95%可信区间，0.45 - 1.02）。这些试验中809例患者报告的总体死亡率显示，与对照组相比，接受IVIG治疗的患者死亡率的优势比为0.74（0.55 - 0.99）（数值<1.0表明IVIG在预防该事件方面有效）。最近有研究表明，在无低丙种球蛋白血症的情况下，从第90天至360天每月给予IVIG（500 mg/kg）并不能降低慢性GVHD或晚期并发症的发生率。未来的研究旨在确定每周预防性使用IVIG抑制急性GVHD的作用机制以及IVIG预防在接受无关骨髓移植患者中的作用。
