In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT

• Published in: Bone marrow transplantation (Basingstoke) Vol. 47; no. 1; pp. 101 - 106
• Main Authors: Dominietto, A, Tedone, E, Soracco, M, Bruno, B, Raiola, A M, Van Lint, M T, Geroldi, S, Lamparelli, T, Galano, B, Gualandi, F, Frassoni, F, Bacigalupo, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2012; Nature Publishing Group
• Subjects: Acute Disease; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antibodies, Viral - blood; Antilymphocyte Serum - administration & dosage; B cells; B-Lymphocytes; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Chronic Disease; Disease-Free Survival; DNA, Viral - blood; Epstein-Barr virus; Epstein-Barr Virus Infections - blood; Epstein-Barr Virus Infections - mortality; Epstein-Barr Virus Infections - prevention & control; Female; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Herpesvirus 4, Human; Humans; Immunoglobulin G - blood; Immunologic Factors - administration & dosage; Infectious diseases; Internal Medicine; Lymphocyte Depletion - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; original-article; Physiological aspects; Public Health; Retrospective Studies; Risk Factors; Rituximab; Stem cell transplantation; Stem Cells; Survival Rate; Tissue Donors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning; Viral diseases; Viremia; Italy; EBV; alternative donors; acute GvHD; unrelated; rituximab; Antineoplastic agent; Stem cell; Hematopoietic cell; Epstein Barr virus; Monoclonal antibody; Immunotherapy; Gammaherpesvirinae; Immunopathology; Graft versus host disease; Hematology; Unrelated donor; Herpesviridae; Acute; Rituximab; B-Lymphocyte; Infection; Virus; Immunomodulator; In vivo; Depletion; Treatment; Viral disease; Immunosuppressive agent
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2011.28

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.