Immunoglobulin in Patients with Stem-Cell Transplants. Ann Intern Med. 2003;139:I-45. doi: 10.7326/0003-4819-139-1-200307010-00002
Download citation file:
Published: Ann Intern Med. 2003;139(1):I-45.
Stem cells are immature blood cells that mature into red blood cells, white blood cells, and platelets. The mature cells carry oxygen to tissues, defend against infection, and prevent bleeding. Life-threatening problems result if patients do not produce stem cells or if powerful cancer treatments or immune body processes destroy stem cells. In either instance, doctors can replace stem cells and restore the body's ability to produce the blood cells that the patient needs. One method that doctors may use is allogeneic stem-cell transplantation (ASCT). In this type of transplantation, patients receive healthy stem cells from another person.
Patients who have ASCT are given powerful drugs that suppress the immune system. These drugs help prevent the body from rejecting the transplant and also prevent transplanted cells from harming the patient's existing cells (graft-versus-host disease). As a result, these patients have problems fighting infections. To help prevent the infections, doctors may give patients a drug that contains antibodies (immunoglobulin). Whether immunoglobulin actually benefits the patients, however, is not proven.
To find out whether immunoglobulin is better than placebo (dummy medicine) in preventing adverse results in patients who have ASCT.
200 patients who had ASCT from 19 French transplantation centers.
The researchers randomly assigned patients to receive either placebo or one of three dose levels of immunoglobulin. All treatments were given as solutions through a vein once a week. They were started the week before ASCT and were continued until 100 days after ASCT. Neither the researchers nor the patients knew which patients received which solution. The researchers followed patients closely for 180 days after ASCT to assess infections, inflammation between spaces of cells in the lung (interstitial pneumonia), and whether the transplanted cells were toxic for the patient (graft-versus-host disease). They then compared results among the groups.
About 90% of the patients in each group had at least one infection. No major differences were seen between groups in total numbers of infections, interstitial pneumonia, graft-versus-host disease, and deaths. In addition, there was no clear evidence that higher doses of immunoglobulin worked better than lower doses. Patients given higher doses of immunoglobulin had side effects, such as fever and chills, more often than did other patients.
The study had a limited ability to detect differences in graft-versus-host disease among groups. It could have missed a lower incidence of this problem in patients given higher doses of immunoglobulin.
Immunoglobulin does not prevent infections or graft-versus-host disease in people undergoing ASCT.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only