Document Detail


Rituximab administration within 6 months of T cell-depleted allogeneic SCT is associated with prolonged life-threatening cytopenias.
MedLine Citation:
PMID:  20580848     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The monoclonal anti-CD20 antibody Rituximab (RTX) is increasingly used in allogeneic stem cell transplantation (SCT) to treat lymphoproliferative disorders and chronic graft-versus-host disease (GVHD). RTX administration can be complicated by delayed and prolonged neutropenia, but the mechanism is unclear. We report the occurrence of profound cytopenias following RTX given in the conditioning regimen or early after T cell-deplete SCT to treat B cell lymphoproliferative disorders or chronic GVHD (cGVHD). Between 2006 and 2009, 102 patients (median age: 43 years, range: 13-68 years), received a myeloablative matched-sibling T cell-deplete SCT for lymphoid or myeloid hematologic disorders. Neutropenia occurring within 4 weeks of treatment developed in 16 of 17 patients given RTX within the first 190 days after SCT. Fourteen patients developed severe neutropenia (count <0.5 K/μL) lasting up to 10 months and 12 required hospitalization to treat severe neutropenic infections. Six of the 14 patients died of infection complicating GVHD treatment. Recovery of lymphocytes and immunoglobulins was also delayed, with a significantly lower absolute lymphocyte counts (ALC) at 9 months and 12 months post-SCT compared to patients with cGVHD not treated with early RTX (P < .02). In contrast, patients receiving RTX 1 year after SCT experienced only moderate neutropenia 3 to 5 months after treatment lasting 10 to 20 days while maintaining absolute neutrophil count (ANC) >1.0 × 10⁹/L. Although RTX rapidly controlled cGVHD, we conclude that its administration early after T cell-deplete SCT is associated with prolonged profound and life-threatening cytopenias, and should be avoided.
Authors:
Zachariah McIver; Nicole Stephens; Andrew Grim; A John Barrett
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2010-05-24
Journal Detail:
Title:  Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation     Volume:  16     ISSN:  1523-6536     ISO Abbreviation:  Biol. Blood Marrow Transplant.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-12     Completed Date:  2011-03-04     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9600628     Medline TA:  Biol Blood Marrow Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1549-56     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Stem Cell Allotransplantation Section, Hematology Branch, Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. mciverza@nhibi.nih.gov
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Antibodies, Monoclonal, Murine-Derived / administration & dosage,  adverse effects*,  therapeutic use
Blood Cell Count
Erythrocyte Count
Graft vs Host Disease / drug therapy*,  prevention & control
Hematologic Neoplasms / therapy
Humans
Immunoglobulin G / blood
Immunoglobulin M / blood
Immunologic Factors / administration & dosage,  adverse effects,  therapeutic use
Immunosuppressive Agents / administration & dosage,  adverse effects,  therapeutic use
Lymphocyte Depletion*
Lymphocytes / pathology
Lymphopenia / chemically induced,  etiology*,  pathology
Middle Aged
Neutropenia / chemically induced,  etiology*,  pathology
Neutrophils / pathology
Platelet Count
Proportional Hazards Models
Risk Factors
Stem Cell Transplantation / methods*,  mortality
T-Lymphocytes / cytology*
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Murine-Derived; 0/Immunoglobulin G; 0/Immunoglobulin M; 0/Immunologic Factors; 0/Immunosuppressive Agents; 0/rituximab
Comments/Corrections

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