Document Detail


Pre-emptive rituximab based on viraemia and T cell reconstitution: a highly effective strategy for the prevention of Epstein-Barr virus-associated lymphoproliferative disease following stem cell transplantation.
MedLine Citation:
PMID:  21910716     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study investigated the efficacy of a pre-emptive strategy based on the combination of Epstein-Barr virus (EBV) viraemia and poor T cell reconstitution in preventing post-transplant lymphoproliferative disease (PTLD) following T cell depleted stem cell transplant (SCT). EBV viral load and immune reconstitution were prospectively monitored in 70 consecutive children undergoing SCT following reduced intensity conditioning with alemtuzumab. Patients who developed significant EBV viraemia (> 40 000 copies/ml blood) were treated pre-emptively with rituximab if they were within 3 months of SCT or their CD3 count was <0·3 × 10⁹ /l. Of 20/70 patients who developed significant EBV viraemia, 13 received pre-emptive rituximab. The incidence of PTLD was significantly reduced in the pre-emptive cohort compared to historical controls (1·4% vs. 21·7%, P = 0·003). This difference was more marked among viraemic patients (2·7% vs. 62·5%P < 0·0001). Patients treated with rituximab demonstrated significantly delayed B cell reconstitution at 1 year post-SCT but this was not associated with an increase in infectious mortality. In 6/6 patients >3 months post-SCT who had a CD3 count >0·3 × 10⁹ /l, reduced immunosuppression only resulted in successful resolution of EBV viraemia without PTLD. This strategy is safe and highly effective in preventing PTLD following T cell depleted SCT, and directs rituximab therapy to patients at highest risk of this complication.
Authors:
Austen Worth; Rachel Conyers; Jonathon Cohen; Mamta Jagani; Robert Chiesa; Kanchana Rao; Nicholas Goulden; Paul Veys; Persis J Amrolia
Related Documents :
21789646 - Laparoscopic dor versus toupet fundoplication following heller myotomy for achalasia: r...
21643866 - Radiology-led follow-up system for ivc filters: effects on retrieval rates and times.
22100466 - The impact of an ed-only full-capacity protocol.
22085766 - A retrospective observational study on the efficacy of colistin by inhalation as compar...
19662486 - Comparison of the effects of short- and long-pulse durations when using a 585-nm pulsed...
6795526 - Nonsurgical management of spontaneous intracerebral hematoma.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-09-13
Journal Detail:
Title:  British journal of haematology     Volume:  155     ISSN:  1365-2141     ISO Abbreviation:  Br. J. Haematol.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-12     Completed Date:  2012-01-30     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0372544     Medline TA:  Br J Haematol     Country:  England    
Other Details:
Languages:  eng     Pagination:  377-85     Citation Subset:  IM    
Copyright Information:
2011 Blackwell Publishing Ltd.
Affiliation:
Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antibodies, Monoclonal, Humanized / administration & dosage
Antibodies, Monoclonal, Murine-Derived / therapeutic use*
Antibodies, Neoplasm / administration & dosage
Child
Child, Preschool
Cohort Studies
Epstein-Barr Virus Infections / etiology,  immunology,  prevention & control*,  virology
Female
Herpesvirus 4, Human / physiology*
Humans
Lymphoproliferative Disorders / etiology,  immunology,  prevention & control*,  virology
Male
Prospective Studies
Stem Cell Transplantation / adverse effects,  methods*
T-Lymphocytes / drug effects,  immunology*
Viremia / etiology,  immunology,  prevention & control,  virology
Virus Activation
Young Adult
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Monoclonal, Murine-Derived; 0/Antibodies, Neoplasm; 0/rituximab; 3A189DH42V/alemtuzumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  MYH9 and APOL1 are both associated with sickle cell disease nephropathy.
Next Document:  microRNA regulation in megakaryocytopoiesis.