Cytomegalovirus immunoglobulins in the prevention and treatment of cytomegalovirus disease.

For the past decade, evidence of a significant role for antibody in modifying cytomegalovirus (CMV) disease has been accumulating. In prospective studies of renal transplant recipients, prophylactic administration of CMV hyperimmunoglobulin reduced by 50% the clinical manifestations of primary CMV disease. CMV hyperimmunoglobulin had no effect on infection rates, but a trend toward a decreased rate of viremia was evident. Its protective effect was attenuated by increased immunosuppression, e.g., by use of antilymphocyte serum or monoclonal antibody for antirejection therapy. In bone marrow transplantation studies, large doses of hyperimmune plasma or gamma-globulin decreased rates of CMV pneumonia or interstitial pulmonary infiltrates. The mechanism of globulin protection has yet to be defined. Data on liver or heart transplantation are insufficient to permit a meaningful statement about efficacy of immunoglobulin for CMV prophylaxis. Preliminary uncontrolled studies suggest that high-dose immunoglobulin plus ganciclovir may be more effective than ganciclovir alone for treating CMV pneumonia in bone marrow transplant recipients. Questions remain unanswered about the use of CMV immunoglobulin in other settings or with antiviral therapy for prophylaxis.