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Evidence summaries

Immunoglobulin Prophylaxis in Hematological Malignancies and Hematopoietic Stem Cell Transplantation

In patients undergoing hematopoietic stem cell transplantation (HSCT), or in patients with lymphoproliferative disorders (LPD), prophylaxis with intravenous immunoglobulins (IVIG) appears not to decrease all-cause mortality. Its use may be considered in LPD patients with hypogammaglobulinemia and recurrent infections, for reduction of clinically documented infections. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 40 studies with a total of 4 682 subjects. Thirty (4 223 patients) included hematopoietic stem cell transplantation (HSCT) patients and ten (459 patients) included patients lymphoproliferative disorders (LPD). When polyvalent immunoglobulins or hyperimmune cytomegalovirus (CMV)-intravenous immunoglobulins (IVIG) were compared to control for HSCT, there was no difference in all-cause mortality RR 0.97 (95% CI 0.87 to 1.09, 12 trials 1 706 patients). Polyvalent immunoglobulins significantly reduced the risk for interstitial pneumonitis (RR 0.64, 95% CI 0.45 to 0.89, 7 trials, 990 patients) but increased the risk for veno-occlusive disease (RR 2.73, 95% CI 1.11 to 6.71, 4 trials 447 patients) and adverse events (RR 8.12 95% CI 3.15 to 20.97, 5 trials 728 patients). In LPD, no benefit in terms of mortality IVIG could be demonstrated (RR 0.86, 95% CI 0.63 to 1.16, 2 trials 163 patients) but there was a decrease in clinically (RR 0.49, 95% CI 0.39 to 0.61) and microbiologically (RR 0.71, 95% CI 0.53 to 0.95) documented infections (3 trials, 205 participants).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).

References

  • Raanani P, Gafter-Gvili A, Paul M, Ben-Bassat I, Leibovici L, Shpilberg O. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. Cochrane Database Syst Rev 2008 Oct 8;(4):CD006501. [PubMed]

Primary/Secondary Keywords