IVIG post transplantation – pro

Intravenous gammaglobulin is often administered after bone marrow/ stem cells transplantation to prophylax for infections. Antibiotics and intravenous gamma globulin are often adminstered for at least 100 days after transplant to decrease the risk of bacterial infection immediately following transplant. Although there are no randomized studies of this strategy, it is recommended by the joint guidelines of CDC, the Infectious Disease Society of America, and the American Society of Blood and Bone Marrow Transplantation. For actually hypogammaglobulinemic patients a higher dose is used than than is standard for non-HSCT recipients because the IVIG half-life among HSCT recipients (generally 1–10 days) is much shorter than the half-life among healthy adults (generally 18–23 days) (therefore, the IVIG dose for a hypogammaglobulinemic recipient should be individualized to maintain trough serum IgG concentrations >400–500 mg/dl (should monitor trough serum IgG concentrations among these patients approximately every 2 weeks and adjust IVIG doses as needed.

In their recently published meta-analysis of prophylactic intravenous immunoglobulin (IVIG) in allogeneic stem cell transplantation (alloSCT), Raanani et al concluded that IVIG does not have a role in SCT. The debate continues but guidelines currently recommend it.

Stanley C. Jordan, Ashley A. Vo, Mieko Toyoda, Dolly Tyan, Cynthia C. Nast (2005)
Post-transplant therapy with high-dose intravenous gammaglobulin: Applications to treatment of antibody-mediated rejection Pediatric Transplantation 9 (2), 155–161.

Antin, JH. Long-term care after hematopoietic-cell transplantation in adults. N Engl J Med. 2002; 347(1):36-42.

Uptodate, Prevention of infections in hematopoietic cell transplant recipients, 2016
Andrew J. Ullmann et al, Published online 2016 Jun 24. Infections in haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol. 2016; 95: 1435–1455

Raanani P, Gafter-Gvili A, Paul M, et al: Immunoglobulin prophylaxis in hematopoietic stem cell transplantation: Systematic review and meta-analysis. J Clin Oncol 27:770-781, 2009

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