title: Serum concentrations of immunoglobulins and of antibody isotypes in bone marrow transplant recipients treated with high doses of polyspecific immunoglobulin or with cytomegalovirus hyperimmune globulin.
abstract: The kinetics of immunoglobulins (Ig) and antibodies were followed in 10 bone marrow transplant recipients who received either high doses (0.5 g/kg body weight) of polyspecific intravenous Ig (HD-IVIG) weekly or cytomegalovirus hyper-Ig (CMV-IVIG, 0.1 g/kg body weight) every 3 weeks. In the HD-IVIG group, the mean total IgG concentration more than tripled and similar significant increases were seen for IgG1 and IgG2. IgG antibodies to CMV showed a marked increase in the HD-IVIG and a less pronounced rise in the CMV-IVIG group. IgM antibodies to CMV were present initially or became detectable in five patients, unrelated to the IVIG preparation. HD-IVIG induced a significant increase of IgG antibodies to streptococcal group A carbohydrate (A-CHO) and to smooth strain lipopolysaccharides (LPS) but not of antibodies against lipid-A. When the Ig treatment was discontinued, levels of total IgG and of IgG antibody to CMV decreased with an apparent half-life of 30 days. Both IVIG preparations were well tolerated and had no negative feedback on total Ig and on specific antibody production or other antimicrobial defence mechanisms. In patient nos. 4 and 10 who developed severe graft-versus-host-disease, transient serum Ig peaks including several Ig isotypes appeared after day 14. In patient no. 10 this peak contained an IgG antibody to H. influenzae type b (Hib), and IgM antibodies to CMV, Hib, A-CHO and LPS. This study clearly shows that serum concentrations of Ig isotypes, subtypes and specific antibodies, depend on at least four factors: total amount and composition of Ig infused, consumption, catabolism and endogenous production.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.forename: J E
authors.initials: JE
authors.lastname: Doran
authors.forename: P
authors.initials: P
authors.lastname: Bachmann
authors.forename: R
authors.initials: R
authors.lastname: Scherz
authors.forename: P
authors.initials: P
authors.lastname: Späth
authors.forename: C
authors.initials: C
authors.lastname: Baumgartner
authors.forename: B
authors.initials: B
authors.lastname: Perret
authors.forename: C
authors.initials: C
authors.lastname: Berger
authors.forename: C
authors.initials: C
authors.lastname: Nissen
authors.forename: A
authors.initials: A
authors.lastname: Tichelli
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000008:administration & dosage; D016026:Bone Marrow Transplantation / Q000276:immunology*; D003131:Combined Modality Therapy; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D006801:Humans; D007132:Immunoglobulin Isotypes / Q000097:blood*; D007136:Immunoglobulins / Q000008:administration & dosage / Q000378:metabolism*; D007700:Kinetics; D007938:Leukemia / Q000276:immunology / Q000601:surgery / Q000628:therapy; D008297:Male
chemical_list: D000914:Antibodies, Viral; D007132:Immunoglobulin Isotypes; D007136:Immunoglobulins