IMMUNOMODULATORY AND ANTIMICROBIAL EFFICACY OF INTRAVENOUS IMMUNOGLOBULIN IN BONE-MARROW TRANSPLANTATION
IMMUNOMODULATORY AND ANTIMICROBIAL EFFICACY OF INTRAVENOUS IMMUNOGLOBULIN IN BONE-MARROW TRANSPLANTATION
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DOI：
10.1056/nejm199009133231103
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发表时间：
1990-09-13
影响因子：
158.5
通讯作者：
STORB, R
中科院分区：
文献类型：
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作者：
SULLIVAN, KM;KOPECKY, KJ;STORB, R
背景：移植物抗宿主病（GVHD）和感染是同种异体骨髓移植的主要并发症。由于静脉注射免疫球蛋白在多种免疫缺陷和自身免疫性疾病中显示出益处，我们研究了其在骨髓移植后的抗菌和免疫调节作用。方法：在一项382例患者的随机试验中，移植受者给予免疫球蛋白（移植后每公斤体重500毫克，每周至第90天，然后每月至第360天）与未给予免疫球蛋白的对照组进行比较。偶然的是，免疫球蛋白组包括更多的晚期肿瘤患者；除此之外，研究组的预后因素是平衡的。结果：对照组巨细胞病毒血清阴性患者接受血清阴性血制品后仍呈血清阴性，但血清阴性患者接受免疫球蛋白和筛查血后巨细胞病毒抗体被动转移（中位效价为1:64）。61例可评价血清阴性的患者中，无一例感染间质性肺炎；在308例血清阳性患者中，22%的对照组患者和13%的免疫球蛋白受体患者出现了这种并发症（P = 0.021）。对照组患者发生革兰氏阴性败血症（相对危险度= 2.65,P = 0.0039）和局部感染（相对危险度= 1.36,P = 0.029）的风险增加，血小板数量比免疫球蛋白组多51个单位。免疫球蛋白没有改变患者的生存和复发风险。然而，在患者中。20岁时，急性GVHD的发生率降低（对照组为51%，免疫球蛋白受体为34%，P = 0.0051）， hla -同型骨髓移植后因移植相关原因导致的死亡率降低（46%对30%，P = 0.023）。结论：静脉注射免疫球蛋白的被动免疫治疗可降低骨髓移植后急性GVHD、相关间质性肺炎和感染的风险。
Background: Graft-versus-host disease (GVHD) and infection are major complications of allogeneic bone marrow transplantation. Since intravenous immunoglobulin has shown benefit in several immunodeficiency and autoimmune disorders, we studied its antimicrobial and immunomodulatory role after marrow transplantation. Methods: In a randomized trial of 382 patients, transplants recipients given immunoglobulin (500 mg per kilogram of body weight weekly to day 90, then monthly to day 360 after transplantation) were compared with controls not given immunoglobulin. By chance, the immunoglobulin group included more patients with advanced-stage neoplasms; otherwise, the study groups were balanced for prognostic factors. Results: Control patients seronegative for cytomegalovirus who received seronegative blood products remained seronegative, but seronegative patients who received immunoglobulin and screened blood had a passive transfer of cytomegalovirus antibody (median titer, 1:64). Among the 61 seronegative patient who could be evaluated, none contracted interstitial pneumonia; among the 308 seropositive patients evaluated, 22 percent of control patients and 13 percent of immunoglobulin recipients had this complication (P = 0.021). Control patients had an increased risk of gram-negative septicemia (relative risk = 2.65, P = 0.0039) and local infection (relative risk = 1.36, P = 0.029) and received 51 more units of platelets than did immunoglobulin recipients. Neither survival nor the risk of relapse was altered by immunoglobulin. However, among patients .gtoreq. 20 years old, there was a reduction in the incidence of acute GVHD (51 percent in controls vs. 34 percent in immunoglobulin recipients; P = 0.0051) and a decrease in deaths due to transplants-related causes after transplantation of HLA-identical marrow (46 percent vs. 30 percent; P = 0.023). Conclusions: Passive immunotherapy with intravenous immunoglobulin decreases the risk of acute GVHD, associated interstitial pneumonia, and infections after bone marrow transplantation.