TY - JOUR
T1 - Immunoglobulin prophylaxis in chronic lymphocytic leukemia and multiple myeloma
T2 - Systematic review and meta-analysis
AU - Raanani, Pia
AU - Gafter-Gvili, Anat
AU - Paul, Mical
AU - Ben-Bassat, Isaac
AU - Leibovici, Leonard
AU - Shpilberg, Ofer
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
KW - Chronic lymphocytic leukemia
KW - Immunoglobulin prophylaxis
KW - Lymphoproliferative disorders
KW - Multiple myeloma
KW - Plasma cell disorders
UR - http://www.scopus.com/inward/record.url?scp=68449089448&partnerID=8YFLogxK
U2 - 10.1080/10428190902856824
DO - 10.1080/10428190902856824
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C2 - 19330654
AN - SCOPUS:68449089448
SN - 1042-8194
VL - 50
SP - 764
EP - 772
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 5
ER -