title: Intrathecal therapy with rituximab in central nervous system involvement of post-transplant lymphoproliferative disorder.
abstract: Post-transplant lymphoproliferative disorder (PTLD) caused by Epstein-Barr virus (EBV) is a severe complication in high-risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. Central nervous system (CNS) involvement of PTLD is a very rare event in patients with HSCT. As no established standard therapy in CNS-EBV-PTLD is available, the aim of this study was analysis of the safety and efficacy of intrathecal rituximab therapy in a group of eight children and adolescents with CNS-EBV-PTLD. Seven patients responded to therapy: all clinical symptoms and EBV-DNA viral load resolved after a median 2 (range: 1-7) doses of rituximab. However, some magnetic resonance imaging (MRI) changes in brain scan persisted in two patients. In all patients, except one, no adverse events of the therapy were observed. In conclusion, intrathecal rituximab administration seems to be an effective and safe method of treatment of CNS-EBV-PTLD in pediatric stem cell recipients. We recommend this treatment modality for further investigation.
authors.affiliation: Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. jstyczynski@cm.umk.pl
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Czyzewski
authors.forename: Jan
authors.initials: J
authors.lastname: Styczynski
authors.forename: Anna
authors.initials: A
authors.lastname: Krenska
authors.forename: Robert
authors.initials: R
authors.lastname: Debski
authors.forename: Olga
authors.initials: O
authors.lastname: Zajac-Spychala
authors.forename: Jacek
authors.initials: J
authors.lastname: Wachowiak
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wysocki
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002490:Central Nervous System / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D004854:Herpesvirus 4, Human / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D000069283:Rituximab; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab