title: Immunoglobulin prophylaxis in chronic lymphocytic leukemia and multiple myeloma: systematic review and meta-analysis.
abstract: The role of intravenous immunoglobulins (IVIG) prophylaxis in hypogammaglobulinemic patients with lymphoproliferative disorders (LPD) and plasma cell dyscrasias (PCD) has not been established. We performed a systematic review and meta-analysis of randomized-controlled trials comparing prophylaxis with polyvalent IVIG versus control. The primary outcomes were all-cause mortality and major infections. Nine trials, assessing patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), were included. No survival benefit could be demonstrated, RR 1.36 (95% CI 0.58-3.19, two trials), but there was a significant decrease in the occurrence of major infections, RR 0.45 (95% CI 0.27-0.75, three trials) and a significant reduction in clinically documented infections, RR 0.49 (95% CI 0.39-0.61, three trials). Adverse events, usually not requiring discontinuation of IVIG, occurred significantly more with IVIG. On the basis of the available data, IVIG cannot be recommended routinely for patients with CLL or MM with hypogammaglobulinemia and/or recurrent infections and should be considered on individual basis.
authors.affiliation: Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel. praanani@012.net.il
authors.forename: Pia
authors.initials: P
authors.lastname: Raanani
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.forename: Isaac
authors.initials: I
authors.lastname: Ben-Bassat
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg