Effect of IgM‐enriched intravenous immunoglobulin (Pentaglobin) on endotoxaemia and anti‐endotoxin antibodies in bone marrow transplantation

<jats:p><jats:bold>Abstract. </jats:bold> Endotoxin was measured in over 1000 plasma samples from bone marrow transplant patients in a randomized trial of the IgM‐enriched intravenous immunoglobulin (IVIG) Pentaglobin. Peak endotox aemia was significantly reduced (<jats:italic>P =</jats:italic> 0.02) in patients receiving Pentaglobin and 70% of all pyrexias of unknown origin were associated with endotoxaemia. Gut mucosal damage, assessed by lactulose/mannitol ratios, was significantly associated (<jats:italic>P</jats:italic>= 0.02) with endotoxaemia. Specific IgM antibody to endotoxin core‐glycolipid was significantly raised (<jats:italic>P</jats:italic>&lt;0.01) in patients receiving the IVIG, and the IgM fraction of Pentaglobin was found to contain most of the antiendotoxin antibody activity of the IVIG. These results suggest a role for IgM‐enriched WIG as a prophylactic agent for the reduction of endotoxaemia and its consequences in bone marrow transplant patients.</jats:p>