title: Monitoring and preemptive rituximab therapy for Epstein-Barr virus reactivation after antithymocyte globulin containing nonmyeloablative conditioning for umbilical cord blood transplantation.
abstract: 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.
authors.affiliation: University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota, USA. blaes004@umn.edu
authors.forename: Anne H
authors.initials: AH
authors.lastname: Blaes
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: Young
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
mesh_terms: 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*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000961:Antilymphocyte Serum; D007155:Immunologic Factors; D000069283:Rituximab