Successful treatment of refractory donor lymphocyte infusion-induced immune-mediated pancytopenia with rituximab.
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.
Kato
Itaru
I
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Umeda
Katsutsugu
K
Awaya
Tomonari
T
Yui
Yoshihiro
Y
Niwa
Akira
A
Fujino
Hisanori
H
Matsubara
Hiroshi
H
Watanabe
Ken-Ichiro
K
Heike
Toshio
T
Adachi
Naoto
N
Endo
Fumio
F
Mizukami
Tomoyuki
T
Nunoi
Hiroyuki
H
Nakahata
Tatsutoshi
T
Adachi
Souichi
S
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab