INTRAVENOUS IMMUNOGLOBULIN AND CMV-SERONEGATIVE BLOOD PRODUCTS FOR PREVENTION OF CMV INFECTION AND DISEASE IN BONE-MARROW TRANSPLANT RECIPIENTS

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.