Treatment of central nervous system B lymphoproliferative syndrome by local infusion of a B cell-specific monoclonal antibody.
A 9-month-old infant developed Epstein-Barr virus-induced lymphoproliferative syndrome with mediastinal and central nervous system localizations, associated with mediastinal tuberculosis, 5 months after heart transplantation. As a combination of anti-B cell antibodies (CD21- and CD24-specific) and recombinant interferon alpha 2b, given intravenously, was not effective on the central nervous system disease, the anti-CD21 antibody was infused intrathecally via an Ommaya reservoir. High local concentrations of monoclonal antibodies were achieved, with no adverse effects. A dramatic clinical response was obtained, with clearance of abnormal cells from the cerebrospinal fluid and a clear reduction in the abnormalities on the brain images. The patient is well 7 months later. This observation indicates that treatment of B lymphoproliferative syndrome with central nervous system localization is feasible using a nontoxic, local B cell-specific approach.
Stephan
J L
JL
Unité d'Immunologie, Unité 132 INSERM, Hôpital des Enfants-Malades, Paris, France.
Le Deist
F
F
Blanche
S
S
Le Bidois
J
J
Peuchmaur
M
M
Lellouch-Tubiana
A
A
Hirn
M
M
Griscelli
C
C
Fischer
A
A
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000944:Antigens, Differentiation, B-Lymphocyte / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology; D004854:Herpesvirus 4, Human; D006801:Humans; D016867:Immunocompromised Host; D007167:Immunotherapy; D007223:Infant; D007278:Injections, Spinal; D008232:Lymphoproliferative Disorders / Q000628:therapy*; D008297:Male; D011951:Receptors, Complement / Q000276:immunology*; D017464:Receptors, Complement 3d; D014412:Tumor Virus Infections / Q000628:therapy
D000911:Antibodies, Monoclonal; D000944:Antigens, Differentiation, B-Lymphocyte; D011951:Receptors, Complement; D017464:Receptors, Complement 3d