TY - JOUR
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.
PY - 1993
Y1 - 1993
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% CI, 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.
AB - 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% CI, 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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U2 - 10.7326/0003-4819-118-12-199306150-00004
DO - 10.7326/0003-4819-118-12-199306150-00004
M3 - Article
C2 - 8489107
AN - SCOPUS:0027243294
SN - 0003-4819
VL - 118
SP - 937
EP - 942
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 12
ER -