Originally published as JCO Early Release 10.1200/JCO.2008.16.8450 on December 29 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Raanani, P. Articles by Shpilberg, O. Search for Related Content PubMed PubMed Citation Articles by Raanani, P. Articles by Shpilberg, O. Related Articles Related Correspondence Social Bookmarking                            What's this?

Immunoglobulin Prophylaxis in Hematopoietic Stem Cell Transplantation: Systematic Review and Meta-Analysis

From the Institute of Hematology, Davidoff Cancer Center, Infectious Diseases, Rabin Medical Center, Internal Medicine E, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Corresponding author: Pia Raanani, MD, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel; e-mail: praanani{at}012.net.il.

Purpose Because the role of immunoglobulins (IVIG) prophylaxis in patients undergoing hematopoietic stem-cell transplantation (HSCT) has not been established in terms of survival and infection prevention, we conducted a meta-analysis evaluating these issues.

Methods Systematic review and meta-analysis of randomized-controlled trials comparing prophylaxis with polyvalent IVIG or cytomegalovirus (CMV)-IVIG and control or another preparation or dose. PUBMED, Cochrane Library, LILACS, and conference proceedings were searched. Two reviewers appraised the quality of trials and extracted data. Relative risks (RRs) with 95% CIs were estimated and pooled.

Results Thirty trials including 4,223 patients undergoing bone marrow transplantation (BMT) were included. There was no difference in all-cause mortality when polyvalent IVIG or CMV-IVIG was compared to control (RR, 0.99; 95% CI, 0.88 to 1.12; and RR, 0.86; 95% CI, 0.63 to 1.16, respectively). There was no difference in clinically documented infections when polyvalent IVIG was compared with control (RR, 1.00; 95% CI, 0.90 to 1.10; five trials). CMV infections were not significantly reduced with either polyvalent IVIG or CMV-IVIG. Interstitial pneumonitis was reduced with polyvalent IVIG in older studies but not in the more recent ones, nor in studies assessing CMV-IVIG. Polyvalent IVIG increased the risk for veno-occlusive disease (RR, 2.73; (95% CI, 1.11 to 6.71). Graft-versus-host disease was not affected.

Conclusion Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Prophylactic Intravenous Immunoglobulin Does Not Have a Role in Hematopoietic Stem-Cell Transplantation: Is the Evidence Clear?
  Nishitha Reddy, Stacey Goodman, and Bipin N. Savani
  JCO 2009 27: 2296-2297 [Full Text]

This article has been cited by other articles:

				N. Reddy, S. Goodman, and B. N. Savani Prophylactic Intravenous Immunoglobulin Does Not Have a Role in Hematopoietic Stem-Cell Transplantation: Is the Evidence Clear? J. Clin. Oncol., May 1, 2009; 27(13): 2296 - 2297. [Full Text] [PDF]

				P. Raanani, A. Gafter-Gvili, M. Paul, I. Ben-Bassat, L. Leibovici, and O. Shpilberg Reply to N. Reddy et al J. Clin. Oncol., May 1, 2009; 27(13): 2297 - 2298. [Full Text] [PDF]