ABSTRACT
Intravenous immunoglobulin (IVIG) has been used for over two decades as part of the treatment regimen for chemoablated recipients of allogeneic bone marrow stem cell transplants, and has been approved by the US Food and Drug Administration for this indication1. Part of the rationale for using it is that a passive antibody might prevent infections in these iatrogenically neutropenic and T cell-immunosuppressed patients, particularly the highly problematic infections caused by cytomegalovirus and the interstitial pneumonia usually attributed to it2. A study performed before the availability of ganciclovir reported that IVIG reduced the incidences of both cytomegalovirus (CMV) infection and interstitial pneumonia in allogeneic bone marrow transplant recipients2. Most subsequent studies have shown that a combination of high-dose IVIG and ganciclovir is superior to each alone3,4. The development of hyperimmune anti-CMV IVIG preparations has led to the preferential use of it over polyclonal IVIG preparations. However, hyperimmune anti CMV IVIG alone did not prevent CMV viremia or pneumonitis nor did it improve 1-year survival in CMV-seropositive lung transplant recipients5. This is unfortunate, considering the rising incidence of ganciclovirresistant CMV organisms6, which is being accelerated by the widespread practice of using ganciclovir prophylactically in many bone marrow and organ transplant centers. Thus, CMV infections continue to be a major contributor to morbidity and mortality after all types of transplantation.
