High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy: A study of the American bone marrow transplant group

Steven N. Wolff, Joseph W. Fay, Roger H. Herzig, John P. Greer, Stephen Dummer, Randy A. Brown, Robert H. Collins, Don A. Stevens, Geoffrey P. Herzig

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Objective: To determine whether intravenous immunoglobulin (IVIG) prevents severe infections during autologous bone marrow transplantation or equivalent high-dose myelosuppressive therapy. Design: Randomized, stratified, nonblinded study. Setting: Three tertiary care university hospitals. Patients: One hundred seventy patients entered the study; 82 received IVIG and 88 were untreated controls. The study groups were similar for parameters capable of influencing the likelihood of infection. Interventions: Intravenous immunoglobulin was given weekly at a dose of 500 mg/kg body weight from the initiation of cytotoxic therapy to the resolution of neutropenia. Measurements: The development of bloodstream or other clinically proven infection, platelet use, and the development of alloimmunity to platelet transfusion. Results: Clinical infection, bacteremia, and fungemia occurred in 43%, 35%, and 6% of the IVIG-treated patients and in 44%, 34%, and 9% of the control patients. Gram-positive bacteremia and gram-negative bacteremia occurred in 28% and 11% of the IVIG group and in 23% and 13% of the control group. Death due to infection occurred in 4.9% of IVIG recipients and in 2.3% of controls. None of these observations was statistically significant (P > 0.2). Survival to hospital discharge was achieved in 86.6% of the IVIG group and in 96.6% of the control group. The survival difference (10%; 95% Cl, 1.7% to 18.3%; P = 0.02) was due to a higher incidence of regimen-related toxic death in the IVIG-treated group. Conclusions: The use of IVIG did not prevent infection. Fewer deaths occurred among controls due to a higher incidence of fatal hepatic veno-occlusive disease in patients receiving IVIG.

Original languageEnglish (US)
Pages (from-to)937-942
Number of pages6
JournalAnnals of Internal Medicine
Volume118
Issue number12
StatePublished - Jun 15 1993

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Autologous Transplantation
Intravenous Immunoglobulins
Bone Marrow Transplantation
Bone Marrow
Transplants
Infection
Bacteremia
Therapeutics
Hepatic Veno-Occlusive Disease
Fungemia
Platelet Transfusion
Control Groups
Survival
Poisons
Incidence
Tertiary Healthcare
Neutropenia
Blood Platelets
Body Weight

ASJC Scopus subject areas

  • Medicine(all)

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High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy : A study of the American bone marrow transplant group. / Wolff, Steven N.; Fay, Joseph W.; Herzig, Roger H.; Greer, John P.; Dummer, Stephen; Brown, Randy A.; Collins, Robert H.; Stevens, Don A.; Herzig, Geoffrey P.

In: Annals of Internal Medicine, Vol. 118, No. 12, 15.06.1993, p. 937-942.

Research output: Contribution to journalArticle

Wolff, Steven N. ; Fay, Joseph W. ; Herzig, Roger H. ; Greer, John P. ; Dummer, Stephen ; Brown, Randy A. ; Collins, Robert H. ; Stevens, Don A. ; Herzig, Geoffrey P. / High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy : A study of the American bone marrow transplant group. In: Annals of Internal Medicine. 1993 ; Vol. 118, No. 12. pp. 937-942.
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abstract = "Objective: To determine whether intravenous immunoglobulin (IVIG) prevents severe infections during autologous bone marrow transplantation or equivalent high-dose myelosuppressive therapy. Design: Randomized, stratified, nonblinded study. Setting: Three tertiary care university hospitals. Patients: One hundred seventy patients entered the study; 82 received IVIG and 88 were untreated controls. The study groups were similar for parameters capable of influencing the likelihood of infection. Interventions: Intravenous immunoglobulin was given weekly at a dose of 500 mg/kg body weight from the initiation of cytotoxic therapy to the resolution of neutropenia. Measurements: The development of bloodstream or other clinically proven infection, platelet use, and the development of alloimmunity to platelet transfusion. Results: Clinical infection, bacteremia, and fungemia occurred in 43{\%}, 35{\%}, and 6{\%} of the IVIG-treated patients and in 44{\%}, 34{\%}, and 9{\%} of the control patients. Gram-positive bacteremia and gram-negative bacteremia occurred in 28{\%} and 11{\%} of the IVIG group and in 23{\%} and 13{\%} of the control group. Death due to infection occurred in 4.9{\%} of IVIG recipients and in 2.3{\%} of controls. None of these observations was statistically significant (P > 0.2). Survival to hospital discharge was achieved in 86.6{\%} of the IVIG group and in 96.6{\%} of the control group. The survival difference (10{\%}; 95{\%} Cl, 1.7{\%} to 18.3{\%}; P = 0.02) was due to a higher incidence of regimen-related toxic death in the IVIG-treated group. Conclusions: The use of IVIG did not prevent infection. Fewer deaths occurred among controls due to a higher incidence of fatal hepatic veno-occlusive disease in patients receiving IVIG.",
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T1 - High-dose weekly intravenous immunoglobulin to prevent infections in patients undergoing autologous bone marrow transplantation or severe myelosuppressive therapy

T2 - A study of the American bone marrow transplant group

AU - Wolff, Steven N.

AU - Fay, Joseph W.

AU - Herzig, Roger H.

AU - Greer, John P.

AU - Dummer, Stephen

AU - Brown, Randy A.

AU - Collins, Robert H.

AU - Stevens, Don A.

AU - Herzig, Geoffrey P.

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Y1 - 1993/6/15

N2 - Objective: To determine whether intravenous immunoglobulin (IVIG) prevents severe infections during autologous bone marrow transplantation or equivalent high-dose myelosuppressive therapy. Design: Randomized, stratified, nonblinded study. Setting: Three tertiary care university hospitals. Patients: One hundred seventy patients entered the study; 82 received IVIG and 88 were untreated controls. The study groups were similar for parameters capable of influencing the likelihood of infection. Interventions: Intravenous immunoglobulin was given weekly at a dose of 500 mg/kg body weight from the initiation of cytotoxic therapy to the resolution of neutropenia. Measurements: The development of bloodstream or other clinically proven infection, platelet use, and the development of alloimmunity to platelet transfusion. Results: Clinical infection, bacteremia, and fungemia occurred in 43%, 35%, and 6% of the IVIG-treated patients and in 44%, 34%, and 9% of the control patients. Gram-positive bacteremia and gram-negative bacteremia occurred in 28% and 11% of the IVIG group and in 23% and 13% of the control group. Death due to infection occurred in 4.9% of IVIG recipients and in 2.3% of controls. None of these observations was statistically significant (P > 0.2). Survival to hospital discharge was achieved in 86.6% of the IVIG group and in 96.6% of the control group. The survival difference (10%; 95% Cl, 1.7% to 18.3%; P = 0.02) was due to a higher incidence of regimen-related toxic death in the IVIG-treated group. Conclusions: The use of IVIG did not prevent infection. Fewer deaths occurred among controls due to a higher incidence of fatal hepatic veno-occlusive disease in patients receiving IVIG.

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