In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT

Abstract

We retrospectively analyzed 55 patients given a fixed dose of rituximab (200 mg) on day þ 5 after an alternative donor transplant, to prevent EBV DNA-emia; 68 alternative transplants who did not receive prophylactic rituximab served as controls. The two groups were comparable for donor type, and all patients received anti-thymocyte globulin in the conditioning regimen. Rituximab patients had a significantly lower rate of EBV DNA-emia 56 vs 85% (P ¼ 0.0004), a lower number of maximum median EBV copies (91 vs 1321/10 5 cells, P ¼ 0.003) and a significantly lower risk of exceeding 1000 EBV copies per 10 5 cells (14 vs 49%, P ¼ 0.0001). Leukocyte and lymphocyte counts were lower on day þ 50 and þ 100 in rituximab patients, whereas Ig levels were comparable. The cumulative incidence of grade II-IV acute GvHD was significantly reduced in rituximab patients (20 vs 38%, P ¼ 0.02). Chronic GvHD was comparable. There was a trend for a survival advantage for patients receiving rituximab (46 vs 40%, P ¼ 0.1), mainly because of lower transplant mortality (25 vs 37%, P ¼ 0.1). Despite the drawback of a retrospective study, these data suggest that a fixed dose of rituximab on day þ 5 reduces the risk of a high EBV load, and also reduces acute GvHD.

Management of Epstein-Barr Virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European Conference on Infections in Leukemia (ECIL-6) guidelines

“…B-cell depletion by prophylactic use of rituximab before or shortly after allo-HSCT might reduce the risk of EBV DNA-emia and PTLD (Table 6). 20,23,69,70 In a large retrospective analysis, prophylactic post-transplant rituximab significantly reduced the risk of EBV DNAemia; however, no statistically significant impact on PTLD incidence, treatment-related mortality, and overall survival in comparison to a pre-emptive approach was demonstrable. 69 Low risk of EBV-PTLD was observed also after the use of post-transplant high-dose cyclophosphamide, 23 or sirolimus as GvHD prophylaxis.…”

Profilaxis de enfermedad por virus de Epstein Barr en niños y adultos receptores de trasplante de órganos sólidos y de precursores hematopoyéticos

“…En caso de positividad, debe reducirse la inmunosupresión en la medida que la condición clínica del paciente y la intensidad de EICH lo permita. Se recomienda indicar rituximab según protocolo [13][14][15][16][17] (C3). El uso de aciclovir o ganciclovir no han demostrado constituir medidas profilácticas efectivas en TOS (C3) ni en TPH (D2) 18 , no siendo recomendada su administración en esquemas de terapia anticipada (pre-emptive).…”

Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients

“… Selective restoration of impaired immune function through the adoptive transfer of EBV-specifi c cytotoxic T-cells has recently been used as pre-emptive treatment for EBV-related PTLD in HSCT patients 17,[33][34][35][36][37][38] . Donorderived T-cells are stimulated, expanded over 3 to 4 weeks, and transferred to patients 17 .…”