[Clinical use of immunoglobulin titers of anti-cytomegalovirus antibodies].
The frequency and severity of CMV infections in kidney, bone marrow, heart transplant recipients, in polytransfused patients, in immunodeficiencies and in newborns with congenital or peri-natal infection prompted clinical trials of immunoglobulins (Ig) with anti-CMV activity. Among the various methods for titrating Ig of plasmatic or placental origin, polyvalent or hyperimmune, ELISA would be the most sensitive assay and the neutralizing reaction might be the better reflection of a protective effect. In kidney transplantation, two non-randomized clinical trials have suggested a curative effect in association to other treatments, especially when given early. In bone marrow transplantation, three randomized studies have shown a prophylactic effect on incidence of symptomatic infections, interstitial pneumonias due to CMV, but only in seronegative patients not treated with leucocyte transfusions. No effect was observed on the time of infection, the survival of patients, the incidence of surinfections or graft versus host disease. The prophylactic effect of anti-CMV Ig in kidney and heart transplantation as well as in newborns has still to be documented in randomized trials. The possible clinical benefit for the patients and the mode of preparation of effective anti-CMV antibodies need further investigations.
D000914:Antibodies, Viral / Q000276:immunology*; D016026:Bone Marrow Transplantation; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control / Q000628:therapy*; D004797:Enzyme-Linked Immunosorbent Assay; D016027:Heart Transplantation; D006801:Humans; D007116:Immunization, Passive; D007167:Immunotherapy; D007231:Infant, Newborn; D016030:Kidney Transplantation; D014184:Transplantation, Homologous / Q000009:adverse effects
D000914:Antibodies, Viral
Utilisation clinique des immunoglobulines titrées en anticorps anti-CMV.