Rituximab Treatment for Epstein-Barr Virus DNAemia after Alternative-Donor Hematopoietic Stem Cell Transplantation

被引：50

作者：

Coppoletta, Stefania ^{[1
]}

Tedone, Elisabetta ^{[1
]}

Galano, Barbara ^{[1
]}

Soracco, Monica ^{[1
]}

Raiola, Anna Maria ^{[1
]}

Lamparelli, Teresa ^{[1
]}

Gualandi, Francesca ^{[1
]}

Bregante, Stefania ^{[1
]}

Ibatici, Adalberto ^{[1
]}

di Grazia, Carmen ^{[1
]}

Dominietto, Alida ^{[1
]}

Varaldo, Riccardo ^{[1
]}

Bruno, Barbara ^{[1
]}

Frassoni, Francesco ^{[1
]}

Van Lint, Maria Teresa ^{[1
]}

Bacigalupo, Andrea ^{[1
]}

机构：

[1] Osped San Martino Genova, Div Hematol & Bone Marrow Transplant, I-16132 Genoa, Italy

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2011年 / 17卷 / 06期

关键词：

Unrelated transplants; mabthera; PTLD; POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER; MONOCLONAL-ANTIBODY RITUXIMAB; PREEMPTIVE RITUXIMAB; EBV REACTIVATION; DISEASE; RECIPIENTS; THERAPY; PREVENTION; PTLD; SCT;

D O I：

10.1016/j.bbmt.2010.10.003

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We report 55 patients undergoing an alternative-donor hematopoietic stem cell transplantation (HSCT) who developed Epstein-Barr virus (EBV) DNAemia, with >1000 EBV copies/10(5) peripheral blood mononuclear cells (PBMCs), and were treated with rituximab (375 mg/m(2)). 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/10(5) PBMCs (range, 1-5770 copies/10(5) PBMCs). The number of EBV copies was reduced to <1000/10(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 <1000 EBV copies/10(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. Biol Blood Marrow Transplant 17: 901-907 (2011) Published by Elsevier Inc. on behalf of American Society for Blood and Marrow Transplantation

引用

页码：901 / 907

页数：7

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