Premium
Pre‐emptive rituximab for Epstein–Barr virus reactivation after haplo‐hematopoietic stem cell transplantation
Author(s) -
Kobayashi Shogo,
Sano Hideki,
Mochizuki Kazuhiro,
Ohara Yoshihiro,
Takahashi Nobuhisa,
Ohto Hitoshi,
Kikuta Atsushi
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13336
Subject(s) - medicine , rituximab , hematopoietic stem cell transplantation , anti thymocyte globulin , transplantation , immunology , gastroenterology , peripheral blood mononuclear cell , lymphoproliferative disorders , incidence (geometry) , antibody , lymphoma , biochemistry , chemistry , physics , optics , in vitro
Background Epstein–Barr virus‐related post‐transplantation lymphoproliferative disease ( EBV ‐ PTLD ) is a serious complication in hematopoietic stem cell transplantation ( HSCT ) recipients. Methods We conducted a retrospective study to investigate the incidence and potential risk factors for EBV reactivation and to assess the efficacy of the management of EBV reactivation with pre‐emptive rituximab in children who had T‐cell‐replete haploidentical HSCT ( TCR ‐haplo‐ SCT ) with low‐dose anti‐thymocyte globulin ( ATG ). EBV ‐ DNA level in peripheral blood ( PB ) was measured when suspected EBV reactivation were observed. When the EBV ‐ DNA level in PB increased to >1,000 copies/10 6 peripheral blood mononuclear cells ( PBMC ), patients were pre‐emptively treated with rituximab (375 mg/m 2 /dose). Results A total of 19 (50%) of 38 patients received rituximab infusion at a median time of 56 days after HSCT (range, 17–270 days). The median viral load at initiation of therapy was 2,900 copies/10 6 PBMC (range, 1,000–650 000). Pre‐emptive therapy was started after a median of 2 days (range, 0–7 days). The median number of weekly treatment cycles was 2 (range, 1–3). None of the patients developed PTLD or other EBV ‐associated diseases. Conclusion Pre‐emptive rituximab therapy could be a useful strategy for EBV ‐ PTLD in TCR ‐haplo‐ SCT recipients with low‐dose ATG .