Efficacy of immune globulin in preventing complications of bone marrow transplantation: a meta-analysis.
To assess the efficacy of immune globulin in preventing CMV infection, interstitial pneumonia, GVHD and death after BMT, we reviewed and synthesized data from 12 published studies (with 1282 patients) in which immune globulin was used prophylactically in BMT patients, controls were included and clinical outcomes were assessed. Data synthesis indicates that immune globulin significantly reduces fatal CMV infection (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.23-0.99), CMV pneumonia (OR 0.61, CI 0.42-0.89), non-CMV interstitial pneumonia (OR 0.57, CI 0.35-0.95) and total mortality (OR 0.74, CI 0.55-0.99). The reduction in acute GVHD was not quite significant (OR CI 0.45-1.02). Complications decrease with both hyperimmune and conventional immune globulin. For CMV-negative transplant recipients, immune globulin decreases symptomatic CMV infection (OR 0.55, CI 0.31-0.94) and interstitial pneumonia (OR 0.34, CI 0.15-0.77). For CMV-positive recipients, immune globulin prevents interstitial pneumonia (OR 0.45, CI 0.26-0.80) but not symptomatic CMV infection (CI 0.41-2.80). We conclude that immune globulin is efficacious in preventing major complications of BMT in both CMV-negative and CMV-positive recipients.
Bass
E B
EB
Department of Medicine, John Hopkins University, Baltimore, Maryland.
Powe
N R
NR
Goodman
S N
SN
Graziano
S L
SL
Griffiths
R I
RI
Kickler
T S
TS
Wingard
J R
JR
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D002648:Child; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005069:Evaluation Studies as Topic; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D016017:Odds Ratio; D012306:Risk; D016896:Treatment Outcome
D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous