title: Increased infection rate after preemptive rituximab treatment for Epstein-Barr virus reactivation after allogeneic hematopoietic stem-cell transplantation.
abstract: BACKGROUND
  Preemptive rituximab (R) treatment decreases the incidence of Epstein-Barr virus (EBV) posttransplantation lymphoproliferative disease, but the extent of immune deficiency related to R in patients who received allogeneic hematopoietic stem-cell transplantation is unclear. The aim of our study was to evaluate the incidence of late infections and immune reconstitution after preemptive R treatment of EBV infection.
  
  
  METHODS
  Seventy-eight patients receiving preemptive R between January 2005 and January 2010 were studied. Fifty-two of them could be matched with controls (not receiving R) according to administration of antithymoglobulin, stem-cell source and donor type, age and grade of acute graft-versus-host disease.
  
  
  RESULTS
  Among the 78 patients with EBV reactivation treated with R, the 36-month cumulative incidence of bacterial, viral, and fungal infections was 64%, 59%, and 23%, respectively. When compared with controls, bacterial infection incidence was significantly higher in R patients (55% vs. 35%), and a slower reconstitution of B cells was observed. R patients had modest but not significantly higher nonrelapse mortality (35% vs. 15%) than controls.
  
  
  CONCLUSIONS
  R has dramatically decreased risks of posttransplantation lymphoproliferative disease but is followed by a prolonged and profound B-cell deficiency associated with an excess risk of bacterial infection and higher mortality. R should be given with caution, and immunoglobulin replacement should be provided to limit these excess risks.
authors.affiliation: Service d'Hématologie-Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Petropoulou
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Regis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Alienor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Paula
authors.initials: P
authors.lastname: Rodriguez-Otero
authors.forename: Félix
authors.initials: F
authors.lastname: Agbalika
authors.forename: Alexis
authors.initials: A
authors.lastname: Talbot
authors.forename: Antoine
authors.initials: A
authors.lastname: Toubert
authors.forename: Hélène
authors.initials: H
authors.lastname: Moins-Teisserenc
authors.forename: Maryvonnick
authors.initials: M
authors.lastname: Carmagnat
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000187:drug effects*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology*; D008232:Lymphoproliferative Disorders / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab