Successful preemptive therapy with single-dose rituximab for Epstein-Barr virus infection to prevent post-transplant lymphoproliferative disease after pediatric hematopoietic stem cell transplantation

Bo Kyung Kim, Hyoung Jin Kang, Kyung Taek Hong, Hong Yul An, Jung Yoon Choi, Jee Soo Lee, Sung Sup Park, Hee Young Shin

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Abstract

Background: The efficacy of preemptive treatment containing rituximab to prevent post-transplant lymphoproliferative disease (PTLD) in children has not yet been fully elucidated. Methods: We analyzed 19 pediatric patients who developed high Epstein-Barr virus (EBV) DNAemia (EBV viral load of greater than 40 000 copies/mL) after allogeneic hematopoietic stem cell transplantation (HSCT) and were preemptively administered rituximab. Rituximab was intravenously injected at a dose of 375 mg/m2 once the EBV viral load was greater than 40 000 copies/mL. Results: In all 19 patients, EBV DNAemia was eradicated after a median of 9 days (range, 3-20 days), and PTLD did not occur. One patient had transient fever, and four patients did not fully recover B cell counts after transplantation. We suggested that delayed B cell recovery was caused by chronic graft-versus-host disease (GVHD) related drugs, not rituximab administration. And there were no other infection-related side effects. Conclusions: In conclusion, preemptive therapy containing rituximab is expected to reduce the incidence of PTLD after HSCT and improve post-transplantation outcomes in children.

Original languageEnglish
Article numbere13182
JournalTransplant Infectious Disease
Volume21
Issue number6
DOIs
StatePublished - 1 Dec 2019

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Keywords

  • Epstein-Barr virus
  • hematopoietic stem cell transplantation
  • post-transplant lymphoproliferative disease
  • rituximab

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