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    
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.
Austen Worth; Rachel Conyers; Jonathon Cohen; Mamta Jagani; Robert Chiesa; Kanchana Rao; Nicholas Goulden; Paul Veys; Persis J Amrolia
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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.
Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK.
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MeSH Terms
Antibodies, Monoclonal, Humanized / administration & dosage
Antibodies, Monoclonal, Murine-Derived / therapeutic use*
Antibodies, Neoplasm / administration & dosage
Child, Preschool
Cohort Studies
Epstein-Barr Virus Infections / etiology,  immunology,  prevention & control*,  virology
Herpesvirus 4, Human / physiology*
Lymphoproliferative Disorders / etiology,  immunology,  prevention & control*,  virology
Prospective Studies
Stem Cell Transplantation / adverse effects,  methods*
T-Lymphocytes / drug effects,  immunology*
Viremia / etiology,  immunology,  prevention & control,  virology
Virus Activation
Young Adult
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Monoclonal, Murine-Derived; 0/Antibodies, Neoplasm; 0/rituximab; 3A189DH42V/alemtuzumab

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