Immunoglobulin prophylaxis in hematopoietic stem cell transplantation: systematic review and meta-analysis.
OBJECTIVE
Because the role of immunoglobulins (IVIG) prophylaxis in patients undergoing hematopoietic stem-cell transplantation (HSCT) has not been established in terms of survival and infection prevention, we conducted a meta-analysis evaluating these issues.


METHODS
Systematic review and meta-analysis of randomized-controlled trials comparing prophylaxis with polyvalent IVIG or cytomegalovirus (CMV)-IVIG and control or another preparation or dose. PUBMED, Cochrane Library, LILACS, and conference proceedings were searched. Two reviewers appraised the quality of trials and extracted data. Relative risks (RRs) with 95% CIs were estimated and pooled.


RESULTS
Thirty trials including 4,223 patients undergoing bone marrow transplantation (BMT) were included. There was no difference in all-cause mortality when polyvalent IVIG or CMV-IVIG was compared to control (RR, 0.99; 95% CI, 0.88 to 1.12; and RR, 0.86; 95% CI, 0.63 to 1.16, respectively). There was no difference in clinically documented infections when polyvalent IVIG was compared with control (RR, 1.00; 95% CI, 0.90 to 1.10; five trials). CMV infections were not significantly reduced with either polyvalent IVIG or CMV-IVIG. Interstitial pneumonitis was reduced with polyvalent IVIG in older studies but not in the more recent ones, nor in studies assessing CMV-IVIG. Polyvalent IVIG increased the risk for veno-occlusive disease (RR, 2.73; (95% CI, 1.11 to 6.71). Graft-versus-host disease was not affected.


CONCLUSIONS
Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.
Raanani
Pia
P
Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel. praanani@012.net.il
Gafter-Gvili
Anat
A
Paul
Mical
M
Ben-Bassat
Isaac
I
Leibovici
Leonard
L
Shpilberg
Ofer
O
D003587:Cytomegalovirus / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D017053:Infection Control / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous