Low dose Rituximab for pre-emptive treatment of Epstein Barr virus reactivation after allogenic hematopoietic stem cell transplantation - 13/03/19

Doi : 10.1016/j.retram.2019.03.001

B. Delapierre ^a, O. Reman ^a, J. Dina ^b, C. Breuil ^c, M. Bellal ^a, H. Johnson-Ansah ^a, A.C. Gac ^a, G. Damaj ^a, S. Chantepie ^a,^⁎
^a Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
^b CHU de Caen, Department of Virology, Normandie Univ, 1400 Caen, France
^c Pharmacie du Centre Hospitalo-universitaire (CHU) de Caen, 14000, Caen, France

^⁎Corresponding author at: Institut d’Hématologie de Basse Normandie, Avenue de la côte de Nacre, 14033, Caen, France.Institut d’Hématologie de Basse NormandieAvenue de la côte de NacreCaen14033France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 March 2019
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Abstract

Introduction

The most used preemptive therapy for Epstein Barr virus reactivation post allogeneic hematopoietic stem cell (HSCT) transplant is Rituximab, 375 mg/m2, once weekly until EBV viremia negativity. There is no data suggesting such a high dose.

Objective

We hypothesized that a lower dose of Rituximab would be as efficient with less toxicity.

Patients

In a retrospective, monocentric study, we analyzed 16 consecutive patients treated preemptively with low dose Rituximab for EBV reactivation post HSCT. Patients were treated with low Rituximab dose of 100 mg/m² weekly. Success was defined by a decrease of EBV viremia of 1 log¹⁰ and below 1000 UI/ml, and the absence of post-transplant lymphoproliferative disorder (PTLD).

Results

Success rate was 93.4% (15/16). One (1/16, 6%) PTLD was diagnosed after preemptive therapy, despite a negative viremia.

Conclusion

A low dose of Rituximab of 100 mg/m² per injection for pre-emptive therapy of EBV reactivation post HSCT is safe and effective for preventing PTLD. Prospective, randomized, multicentric trials with larger number of patient are needed to determine the best rituximab dose.

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Abbreviations : PTLD, HSCT, EBV, EBV-DNA, aGVHD/cGVHD, HLA, ATG, OS, NRM, RFS

Keywords : Hematopoietic stem cell transplantation, Epstein Barr virus, Post transplantation lymphoproliferative disorder, Rituximab