Immune‐Globulin Prophylaxis of Respiratory Syncytial Virus Infection in Patients Undergoing Stem‐Cell Transplantation

Abstract

Thirty-two patients undergoing allogeneic hematopoietic stem-cell transplantation were given respiratory syncytial virus (RSV) immune globulin (RSVIG) at the time of transplantation and again 3 weeks later. Antibody titers to RSV, human parainfluenza virus 3, measles, and influenza H1N1, H3N2, and B were measured prior to administration of RSVIG and 6 more times over the course of the subsequent 6 weeks. Baseline antiviral titers and increases in antibody after administration of RSVIG were extremely variable for all the viruses. In 18 patients in whom the baseline titers of antibody titers to RSV-F protein were 1:640-1:2048, there was a 7.7-fold initial increase in these titers after the first dose of RSVIG, compared with a 2.1-fold increase in 14 patients with baseline titers of 1:4096-1:20,840; increases in titers of antibody against the other viruses after the first dose of RSVIG reflected similar variability. The subset of patients with the lowest titers appear to receive the greatest benefit from administration of RSVIG.

Measles‐Virus–Neutralizing Antibodies in Intravenous Immunoglobulins

“…More recently, it has been suggested that individuals who receive immunoglobulins containing 140 IU of measles antibodies in the total administered dose will be protected from measles disease [25]; unfortunately, that study did not report the measles immune status before treatment and did not measure either peak or trough levels of measles antibody after infusion. Likewise, in a patient cohort undergoing bone-marrow stem-cell transplantation, measles-antibody titers were measured and were found to be у900 mIU/mL after each of 2 infusions of IGIV and were maintained at or above this level for у21 days after the last infusion [26]; however, these patients had preexisting measles immunity, and the reported mnAb levels after immunoglobulin infusion may not reflect the levels achievable in measles-naive individuals with PIDD.…”

Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

“…A non-placebo-controlled study showed that RSV immune globulin significantly increased antiviral titers in patients undergoing transplantation but did not show efficacy in preventing RSV infections because of the low incidence of these infections in the study population. 213 The recent discontinuation of RSV immune globulin manufacturing, however, obviates the need for further debate over the use of RSV immune globulin versus IGIV.…”

Selected populations at increased risk from respiratory syncytial virus infection

“…Most regimens include aerosolized ribavirin and passive immunization with either standard IVIG, RSV hyperimmune globulin (RSV-IGIV) or palivizumab. [15][16][17][18] …”