A Pilot Study Using Intravenous Immunoglobulin for the Prevention of Infection During Remission Induction in Acute Leukaemia.

Abstract

Overwhelming infections cause significant morbidity and mortality in the immunocompromised host. There is considerable in vitro and in vivo evidence that the immune deficient state which accompanies acute leukaemia, and, is exacerbated by intensive chemotherapy, contributes to the infection risk in these patients. The most easily documented and corrected is that of impaired humoral immunity. In order to study the clinical significance of the deficit a double blind, randomised, placebo controlled pilot study was set up designed to test the feasibility, efficacy and toxicity of using prophylactic intravenous immunoglobulin to prevent infective complications in this patient group. Patients received 150 mg/kg of Pentaglobin, an immunoglobulin preparation specifically enriched in IgM and IgA, on days 0, 10 and 20 of the chemotherapy regimes. There were no adverse side effects. Patients in the placebo group had a 25% fall in IgM level whilst IgG and IgA remained unchanged. The treatment group maintained a stable IgM and IgG concentration throughout but had a rise in IgA. There was no difference in the total number of septicaemic episodes in each group but the placebo group had an increased number of non Staphylococcal infections (P < 0.04). We conclude that intravenous Pentaglobin protects patients against a fall in IgM during induction chemotherapy for acute leukaemia and decreases the number of non Staphylococcal infections.