Applications of intravenous immunoglobulin in haematology.
Intravenous immunoglobulin (IVIgG) has many potential applications in haematology both as antibody replacement therapy and as an immune-modulater in autoimmune disorders. Antibody replacement appears to be of value in the prophylaxis of infection in low-grade B-cell malignancies, in bone marrow transplant recipients and in children with AIDS, although optimal treatment strategies have not been assessed and determining which patients are likely to derive greatest benefit has been problematic. IVIgG appears to be effective in the prevention or amelioration of CMV-related pathology if given frequently and has also dramatically improved the survival of patients with established interstitial pneumonia when used in combination with ganciclovir. Intriguingly, IVIgG appears to moderate the severity of GVHD in adult transplant recipients. IVIgG has short term efficacy in most patients with ITP but, as long term remissions are uncommon, it has become necessary to be more selective in the use of IVIgG in this disorder. The response to IVIgG in other immune-mediated cytopenias is similar with generally transient improvement but also with occasional spectacular cures. The treatment of the acquired haemophilias with IVIgG has yielded in vivo and vitro evidence to support the idiotype-antiidiotype theory of IVIgG immune-modulation and has also demonstrated significant differences in the sensitivity of coagulation factor autoantibodies and alloantibodies to IVIgG therapy. IVIgG has several roles in pregnancy related disorders, including the management of both mother and fetus in ITP during pregnancy, the antenatal and postnatal management of platelet alloimmunisation and also in the management of severe rhesus isoimmunisation. IVIgG is safe and well tolerated. The expense of this therapy should be balanced against the likely gains and the overall costs of alternative approaches.
Todd
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Edinburgh and SE Scotland Blood Transfusion Service, UK.
Yap
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PL
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000037:antagonists & inhibitors; D016026:Bone Marrow Transplantation / Q000276:immunology; D015658:HIV Infections / Q000628:therapy; D006402:Hematologic Diseases / Q000628:therapy*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000266:history / Q000627:therapeutic use*; D009369:Neoplasms / Q000276:immunology / Q000628:therapy; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy
D000276:Adjuvants, Immunologic; D001779:Blood Coagulation Factors; D016756:Immunoglobulins, Intravenous