Monitoring and preemptive rituximab therapy for Epstein-Barr virus reactivation after antithymocyte globulin containing nonmyeloablative conditioning for umbilical cord blood transplantation.
Epstein Barr viremia (EBV) and posttransplantation lymphoproliferative disorder (PTLD) are complications of hematopoietic stem cell transplantation (HSCT). The use of antithymocyte globulin (ATG) in recipients of umbilical cord HSCT is a known risk factor for the development of PTLD. In this high-risk population, we implemented an EBV monitoring program with preemptive therapy with rituximab (375 mg/m(2) intravenously [i.v.]) for EBV viremia (>1000 copies/mL). Eight of 35 patients treated with a UCB HSCT between 2007 and 2009, developed EBV viremia. Two of 7 developed PTLD (with 1 of the 2 dying of PTLD), despite prophylactic rituximab use. When compared with our previously described cohort where 6 of 30 developed EBV viremia and 5 of 6 patients developed PTLD (with 2 of 5 dying of PTLD), the incidence of PTLD appears to be less when prophylactic rituximab is administered. Despite small numbers, our observations suggest that in this high-risk population, EBV monitoring accompanied by preemptive therapy may reduce the risk of progression to life-threatening PTLD; further follow-up of this cohort and a larger multi-institutional prospective study of this preemptive strategy is warranted.
Blaes
Anne H
AH
University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota, USA. blaes004@umn.edu
Cao
Qing
Q
Wagner
John E
JE
Young
Jo-Anne H
JA
Weisdorf
Daniel J
DJ
Brunstein
Claudio G
CG
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects; D007155:Immunologic Factors / Q000627:therapeutic use*; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D012307:Risk Factors; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000961:Antilymphocyte Serum; D007155:Immunologic Factors; D000069283:Rituximab