Dj. Winston et al., INTRAVENOUS IMMUNOGLOBULIN AND CMV-SERONEGATIVE BLOOD PRODUCTS FOR PREVENTION OF CMV INFECTION AND DISEASE IN BONE-MARROW TRANSPLANT RECIPIENTS, Bone marrow transplantation, 12(3), 1993, pp. 283-288
The efficacy of iv immunoglobulin plus CMV-seronegative blood products
or CMV-seronogative blood products alone for prevention of CMV infect
ion, symptomatic CMV disease, other infections and GVHD after BMT was
evaluated in a randomized, controlled trial. Fifty-one CMV-seronegativ
e allogeneic BMTs with a CMV-seronegative or CMV-seropositive marrow d
onor were randomly assigned to receive either iv immunoglobulin (1.0 g
/kg once weekly for 120 days after transplant) plus CMV-seronegative b
lood products or CMV-seronegative blood products alone. CMV infection
occurred in 2 of 25 patients (7%) receiving iv immunoglobulin plus CMV
-seronegative blood and in 2 of 23 patients (9%) receiving CMV-seroneg
ative blood alone. All CMV infections were asymptomatic and characteri
zed by viral excretion with or without CMV seroconversion. There were
no cases of CMV-related interstitial pneumonia. Grade greater-than-or-
equal-to II GVHD was less frequent in patients given iv immunoglobulin
(5 of 25 patients (20%) vs. 11 of 23 patients (48%), p = 0.04). The n
umber of bacterial and fungal infections was similar in both groups. F
ewer non-CMV viral infections (9 of 27 patients (33%) vs. 15 of 24 pat
ients (63%), p = 0.03) and fewer deaths associated with infection (1 o
f 27 patients (4%) vs. 5 of 24 patients (21%), p = 0.07) occurred in r
ecipients of immunoglobulin. Neither survival nor risk of leukemia rel
apse was changed by the immunoglobulin. The high doses of iv immunoglo
bulin were well tolerated. These results suggest that CMV-seronegative
blood products alone prevent most CMV infections and CMV disease in C
MV-seronegative allogeneic BMT recipients, even when the marrow donor
is CMV-seropositive. Intravenous immunoglobulin, however, reduces the
incidence and severity of acute GVHD. Survival is not improved bv immu
noglobulin.