TY - JOUR
T1 - Immunoglobulin prophylaxis in hematopoietic stem cell transplantation
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 - 2009/2/10
Y1 - 2009/2/10
N2 - Purpose 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. Conclusion Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.
AB - Purpose 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. Conclusion Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.
UR - http://www.scopus.com/inward/record.url?scp=59949103959&partnerID=8YFLogxK
U2 - 10.1200/JCO.2008.16.8450
DO - 10.1200/JCO.2008.16.8450
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AN - SCOPUS:59949103959
SN - 0732-183X
VL - 27
SP - 770
EP - 781
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 5
ER -