[Is the administration of immunoglobulins following bone marrow transplantation indicated?].
Allogeneic bone marrow transplantation can cure a substantial proportion of patients with hematologic malignancies. However, graft versus host disease (GvHD) and a sometimes long lasting immunodeficiency are the major obstacles to an improved survival rate. Passive immunization is a prophylactic and therapeutic approach increasingly considered in these patients and the question as to whether or not this expensive treatment is efficacious needs thorough evaluation. Several studies have been completed using either polyvalent immunoglobulins or CMV-hyperimmunoglobulin to prevent fatal CMV pneumonia posttransplant. Most studies did show a decreased mortality from this complication when immunoglobulins were given at higher doses in weekly intervals. Studies are also underway to evaluate, if the incidence of GvHD can be decreased by immunoglobulins, since it is known that infections can trigger the clinical manifestation of this complication. It is too early to say if bacterial and fungal infections after engraftment can be diminished specifically in patients at risk for infectious complication such as those with chronic GvHD. A hyperimmunoglobulin against varicella zoster is recommended in case a transplant patient has been exposed to varicella. It can also be given as an additive measure in severe disseminated varicella infections. Hyperimmunoglobulins against pseudomonas aeruginosa are currently being studied in humans and it is too early to decide whether or not they have a positive impact on patient survival.
Klingemann
H G
HG
Department of Medicine, University of British Columbia, Vancouver, Canada.
D016026:Bone Marrow Transplantation; D003586:Cytomegalovirus Infections / Q000628:therapy; D006801:Humans; D007116:Immunization, Passive; D007153:Immunologic Deficiency Syndromes / Q000628:therapy; D011183:Postoperative Complications / Q000628:therapy*; D018805:Sepsis / Q000628:therapy
Gibt es eine Indikation für die Gabe von Immunglobulinen nach Knochenmark-Transplantation?