TY - JOUR
T1 - Rituximab Treatment for Epstein-Barr Virus DNAemia after Alternative-Donor Hematopoietic Stem Cell Transplantation
AU - Coppoletta, Stefania
AU - Tedone, Elisabetta
AU - Galano, Barbara
AU - Soracco, Monica
AU - Raiola, Anna Maria
AU - Lamparelli, Teresa
AU - Gualandi, Francesca
AU - Bregante, Stefania
AU - Ibatici, Adalberto
AU - di Grazia, Carmen
AU - Dominietto, Alida
AU - Varaldo, Riccardo
AU - Bruno, Barbara
AU - Frassoni, Francesco
AU - Van Lint, MariaTeresa
AU - Bacigalupo, Andrea
PY - 2011/6
Y1 - 2011/6
N2 - We report 55 patients undergoing an alternative-donor hematopoietic stem cell transplantation (HSCT) who developed Epstein-Barr virus (EBV) DNAemia, with >1000 EBV copies/105 peripheral blood mononuclear cells (PBMCs), and were treated with rituximab (375 mg/m2). The median patient age was 47 years (range, 20-65 years), and graft sources were mismatched family members (n = 4), unrelated donors (n = 46), and unrelated cord blood (n = 5). The conditioning regimen included antithymocyte globulin (ATG) in all patients. The median time to development of EBV DNAemia was day 27 post-HSCT (range, day 5 to day 242), with a median of 60 EBV copies/105 PBMCs (range, 1-5770 copies/105 PBMCs). The number of EBV copies was reduced to 5 PBMCs on day +7 after initiation of rituximab therapy in 51% of the patients, on day +14 in 73% of the patients, and on +21 in 92% of the patients. Overall, 50 of 55 patients (91%) cleared EBV after one dose (n = 25) or more than one dose (n = 25) of rituximab. Factors predicting transplantation-related mortality (TRM) in multivariate analysis were a reduction to 5 PBMCs by day +7 of treatment (relative risk [RR], 0.2; P = .01) and disease phase in remission (RR, 0.3; P = .05). TRM was 23% in the 40 patients with none or one of the negative predictors and 60% in the 15 patients with both negative predictors (P = .001). Of these latter 15 patients, 3 developed clinical posttransplantation lymphoproliferative disorder (PTLD). All 3 of these patients had a high EBV load on day +7 of rituximab therapy. This study confirms the effectiveness of rituximab in controlling EBV DNAemia in patients undergoing allogeneic HSCT. Patients with increasing EBV copies despite rituximab therapy are at high risk for EBV PTLD and may be considered for alternative therapies.
AB - We report 55 patients undergoing an alternative-donor hematopoietic stem cell transplantation (HSCT) who developed Epstein-Barr virus (EBV) DNAemia, with >1000 EBV copies/105 peripheral blood mononuclear cells (PBMCs), and were treated with rituximab (375 mg/m2). The median patient age was 47 years (range, 20-65 years), and graft sources were mismatched family members (n = 4), unrelated donors (n = 46), and unrelated cord blood (n = 5). The conditioning regimen included antithymocyte globulin (ATG) in all patients. The median time to development of EBV DNAemia was day 27 post-HSCT (range, day 5 to day 242), with a median of 60 EBV copies/105 PBMCs (range, 1-5770 copies/105 PBMCs). The number of EBV copies was reduced to 5 PBMCs on day +7 after initiation of rituximab therapy in 51% of the patients, on day +14 in 73% of the patients, and on +21 in 92% of the patients. Overall, 50 of 55 patients (91%) cleared EBV after one dose (n = 25) or more than one dose (n = 25) of rituximab. Factors predicting transplantation-related mortality (TRM) in multivariate analysis were a reduction to 5 PBMCs by day +7 of treatment (relative risk [RR], 0.2; P = .01) and disease phase in remission (RR, 0.3; P = .05). TRM was 23% in the 40 patients with none or one of the negative predictors and 60% in the 15 patients with both negative predictors (P = .001). Of these latter 15 patients, 3 developed clinical posttransplantation lymphoproliferative disorder (PTLD). All 3 of these patients had a high EBV load on day +7 of rituximab therapy. This study confirms the effectiveness of rituximab in controlling EBV DNAemia in patients undergoing allogeneic HSCT. Patients with increasing EBV copies despite rituximab therapy are at high risk for EBV PTLD and may be considered for alternative therapies.
KW - Mabthera
KW - PTLD
KW - Unrelated transplants
UR - http://www.scopus.com/inward/record.url?scp=79956001828&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79956001828&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2010.10.003
DO - 10.1016/j.bbmt.2010.10.003
M3 - Article
C2 - 20950702
AN - SCOPUS:79956001828
VL - 17
SP - 901
EP - 907
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 6
ER -