title: In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT.
abstract: We retrospectively analyzed 55 patients given a fixed dose of rituximab (200 mg) on day+5 after an alternative donor transplant, to prevent EBV DNA-emia; 68 alternative transplants who did not receive prophylactic rituximab served as controls. The two groups were comparable for donor type, and all patients received anti-thymocyte globulin in the conditioning regimen. Rituximab patients had a significantly lower rate of EBV DNA-emia 56 vs 85% (P=0.0004), a lower number of maximum median EBV copies (91 vs 1321/10(5) cells, P=0.003) and a significantly lower risk of exceeding 1000 EBV copies per 10(5)cells (14 vs 49%, P=0.0001). Leukocyte and lymphocyte counts were lower on day +50 and+100 in rituximab patients, whereas Ig levels were comparable. The cumulative incidence of grade II-IV acute GvHD was significantly reduced in rituximab patients (20 vs 38%, P=0.02). Chronic GvHD was comparable. There was a trend for a survival advantage for patients receiving rituximab (46 vs 40%, P=0.1), mainly because of lower transplant mortality (25 vs 37%, P=0.1). Despite the drawback of a retrospective study, these data suggest that a fixed dose of rituximab on day +5 reduces the risk of a high EBV load, and also reduces acute GvHD.
authors: Divisione Ematologia e Trapianto di Midollo Osseo, Ospedale San Martino, Genova, Italy.
authors: A
authors: A
authors: Dominietto
authors: E
authors: E
authors: Tedone
authors: M
authors: M
authors: Soracco
authors: B
authors: B
authors: Bruno
authors: A M
authors: AM
authors: Raiola
authors: M T
authors: MT
authors: Van Lint
authors: S
authors: S
authors: Geroldi
authors: T
authors: T
authors: Lamparelli
authors: B
authors: B
authors: Galano
authors: F
authors: F
authors: Gualandi
authors: F
authors: F
authors: Frassoni
authors: A
authors: A
authors: Bacigalupo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D000914:Antibodies, Viral / Q000097:blood; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D001402:B-Lymphocytes; D002908:Chronic Disease; D004279:DNA, Viral / Q000097:blood; D018572:Disease-Free Survival; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007155:Immunologic Factors / Q000008:administration & dosage*; D008212:Lymphocyte Depletion / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014766:Viremia
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000914:Antibodies, Viral; D000961:Antilymphocyte Serum; D004279:DNA, Viral; D007074:Immunoglobulin G; D007155:Immunologic Factors; D000069283:Rituximab