Chimaeric anti-CD20 monoclonal antibody (rituximab) in post-transplant B-lymphoproliferative disorder following stem cell transplantation in children.
Post-transplant lymphoproliferative disorder (PTLD) after haemopoietic stem cell transplantation is a serious complication that occurs in 8-22% of patients with high-risk factors. We retrospectively investigated tolerance and efficacy of humanized anti-CD20 monoclonal antibody (rituximab) as first-line treatment in 12 children with B-cell PTLD. At diagnosis, eight patients had tumoral involvement. The other four patients had fever, associated with raised Epstein-Barr virus (EBV) viral load and monoclonal gammopathy. Rituximab was given at the dose of 375 mg/m2 once a week by intravenous infusion (1-9 infusions). Only 1/48 infusions was associated with a grade 2 clinical adverse event. Eight out of 12 (66%) patients responded to the treatment and were in complete remission. All patients without tumoral involvement responded to the treatment. A rapid decrease in fever within 1 week was observed in all responders. Non-responders did not show any clinical response during the first week. Tumoral involvement and immunodepression seemed to be more marked in non-responders. Rituximab was an effective and well-tolerated treatment of B-cell PTLD. Early treatment before tumoral involvement seemed to be the most effective approach. Lack of rapid response should lead to intensification of PTLD treatment. Pre-emptive treatment should be considered and evaluated in further longitudinal multicentre studies.
Faye
A
A
Service d'hémato-immunologie, Hôpital Robert Debré, Paris, France. albert.faye@rdb.ap-hop-paris.fr
Quartier
P
P
Reguerre
Y
Y
Lutz
P
P
Carret
A S
AS
Dehée
A
A
Rohrlich
P
P
Peuchmaur
M
M
Matthieu-Boué
A
A
Fischer
A
A
Vilmer
E
E
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001402:B-Lymphocytes; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D019172:Transplantation Conditioning
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D000069283:Rituximab