title: Successful treatment of refractory donor lymphocyte infusion-induced immune-mediated pancytopenia with rituximab.
abstract: A 6-year-old male with chronic granulomatous disease, who was transplanted with bone marrow and exhibited increasing mixed chimerism, subsequently received two donor lymphocyte infusions (DLI). Two weeks after the second DLI, the patient developed acute graft-versus-host disease (GVHD) and progressive pancytopenia that was associated with autoantibody production. Conventional treatment did not improve the pancytopenia. However, administration of Rituximab (RTX) (375 mg/m(2)/week for four consecutive weeks) resulted in a rapid resolution of the pancytopenia. The patient achieved full donor chimerism without GVHD symptoms. RTX can be valuable for managing immune-mediated cytopenias that arise after DLI and are refractory to conventional therapies.
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Kato
authors.forename: Katsutsugu
authors.initials: K
authors.lastname: Umeda
authors.forename: Tomonari
authors.initials: T
authors.lastname: Awaya
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yui
authors.forename: Akira
authors.initials: A
authors.lastname: Niwa
authors.forename: Hisanori
authors.initials: H
authors.lastname: Fujino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Toshio
authors.initials: T
authors.lastname: Heike
authors.forename: Naoto
authors.initials: N
authors.lastname: Adachi
authors.forename: Fumio
authors.initials: F
authors.lastname: Endo
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Mizukami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nunoi
authors.forename: Tatsutoshi
authors.initials: T
authors.lastname: Nakahata
authors.forename: Souichi
authors.initials: S
authors.lastname: Adachi
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D016026:Bone Marrow Transplantation; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D006105:Granulomatous Disease, Chronic / Q000628:therapy; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D017710:Lymphocyte Transfusion / Q000009:adverse effects*; D008297:Male; D010198:Pancytopenia / Q000188:drug therapy*; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab