Intravenous immunoglobulin in bone marrow transplantation.

Intravenous immunoglobulin (IVIG) has several potential uses in bone marrow transplantation. Most often IVIG is used to modify cytomegalovirus (CMV) infection or CMV-related interstitial pneumonia. It also is used to modify graft versus host disease (GVHD) and decrease infections other than CMV. Another use is to treat autoimmune complications of bone marrow transplants. The data are reviewed indicating that IVIG decreases CMV-related interstitial pneumonia. Part of this efficacy may be a direct antiviral effect; decreasing GVHD and modifying the immune response to CMV-infected lung cells also may be important. Some studies suggest that IVIG and ganciclovir are effective therapy of CMV-related interstitial pneumonia. Results suggesting that IVIG administration decreases infections other than CMV are less convincing. There is little information regarding IVIG therapy of autoimmune transplant complications. These uses of IVIG are reviewed in the context of other potential interventions, and future research directions are defined.