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Septic polyarthritis with Ureaplasma urealyticum in a patient with prolonged agammaglobulinemia and B-cell aplasia after allogeneic HSCT and rituximab pretreatment

Bone Marrow Transplantation volume 40, pages 597–598 (2007)Cite this article

A recent study in this journal1 raised the issue of prolonged hypogammaglobulinemia in patients receiving autologous hematopoietic stem cell transplantation (HSCT) for high-risk B-cell lymphoma and maintenance therapy with rituximab. Despite significant hypogammaglobulinemia, these patients did not experience significant infectious complications. With the following case report, we aim to increase the awareness of the potential for severe infectious complications associated with the hypogammaglobulinemia observed in lymphoma patients given lymphocytotoxic chemotherapy in combination with rituximab before allogeneic HSCT.2

A 28-year-old man with diffuse large B-cell lymphoma (DLBCL) stage IIB in second refractory relapse was referred for an allogeneic HSCT from his HLA-identical sister. He had received primary treatment with eight cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and mediastinal radiotherapy (30 Gy). Three months later, pulmonary relapse was noted and the patient received two cycles of ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin) and surgical tumor debulking. Postoperatively, four weekly doses of rituximab 375 mg/m2 were administered. One week after the last rituximab dose, chemotherapy with BEAM (etoposide, carmustine, cytarabine, melphalan) for debulking was administered, followed by reduced intensity HSCT (fludarabine and 2 Gy total body irradiation) conditioning 1 month later.3 GVHD prophylaxis included methotrexate and CyA. The patient developed acute GVHD of the skin (grade II) and gastrointestinal tract (grade III), overall grade III, which was steroid responsive. Possible pulmonary aspergillosis was treated with voriconazole. CMV reactivation was treated with ganciclovir. At day 100 post transplant, the patient was in complete remission with full donor chimerism, but developed extensive chronic GVHD of moderate severity.

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References

  1. Shortt J, Spencer A . Adjuvant rituximab causes prolonged hypogammaglobulinaemia following autologous stem cell transplant for non-Hodgkin's lymphoma. Bone Marrow Transplant 2006; 38: 433–436.

    Article  CAS  PubMed  Google Scholar 

  2. Goldberg SL, Pecora AL, Alter RS, Kroll MS, Rowley SD, Waintraub SE et al. Unusual viral infections (progressive multifocal leukoencephalopathy and cytomegalovirus disease) after high-dose chemotherapy with autologous blood stem cell rescue and peritransplantation rituximab. Blood 2002; 99: 1486–1488.

    Article  CAS  PubMed  Google Scholar 

  3. Buser AS, Heim D, Bucher C, Tichelli A, Gratwohl A, Passweg JR . High-dose chemotherapy using BEAM for tumor debulking without stem cell support followed by early allogeneic reduced intensity conditioning transplantation to induce a graft-versus-lymphoma effect in patients with high risk or refractory lymphoma. Bone Marrow Transplant 2004; 33: 1011–1014.

    Article  CAS  PubMed  Google Scholar 

  4. Asmar BI, Andresen J, Brown WJ . Ureaplasma urealyticum arthritis and bacteremia in agammaglobulinemia. Pediatr Infect Dis J 1998; 17: 73–76.

    Article  CAS  PubMed  Google Scholar 

  5. Held G, Poschel V, Pfreundschuh M . Rituximab for the treatment of diffuse large B-cell lymphomas. Expert Rev Anticancer Ther 2006; 6: 1175–1186.

    Article  CAS  PubMed  Google Scholar 

  6. Van Besien K . The evolving role of autologous and allogeneic stem cell transplantation in follicular lymphoma. Blood Rev 2006; 20: 235–244.

    Article  CAS  PubMed  Google Scholar 

  7. McLaughlin P, Grillo-Lopez AJ, Link BK, Levy R, Czuczman MS, Williams ME et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol 1998; 16: 2825–2833.

    Article  CAS  PubMed  Google Scholar 

  8. Horwitz SM, Negrin RS, Blume KG, Breslin S, Stuart MJ, Stockerl-Goldstein KE et al. Rituximab as adjuvant to high-dose therapy and autologous hematopoietic cell transplantation for aggressive non-Hodgkin lymphoma. Blood 2004; 103: 777–783.

    Article  CAS  PubMed  Google Scholar 

  9. Cartron G, Blasco H, Paintaud G, Watier H, Le Guellec C . Pharmacokinetics of rituximab and its clinical use: thought for the best use? Crit Rev Oncol Hematol 2007; 62: 43–52.

    Article  PubMed  Google Scholar 

  10. Nishio M, Fujimoto K, Yamamoto S, Endo T, Sakai T, Obara M et al. Delayed redistribution of CD27, CD40 and CD80 positive B cells and the impaired in vitro immunoglobulin production in patients with non-Hodgkin lymphoma after rituximab treatment as an adjuvant to autologous stem cell transplantation. Br J Haematol 2007; 137: 349–354.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported by a grant of the Regional Cancer League Basel-Stadt (CA) and a grant of the Swiss National Research Foundation 3200B0-106105/1 (AG). We thank the stem cell transplantation team and the intensive care unit team for devoted patient care.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland

    C Arber, A Buser, D Heim, A Tichelli, J Passweg & A Gratwohl

  2. Division of Infectious Diseases, Department of Medicine, University Hospital Basel, Basel, Switzerland

    M Weisser

  3. Division of Rheumatology, Department of Medicine, University Hospital Basel, Basel, Switzerland

    A Tyndall

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  1. C Arber
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  2. A Buser
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  3. D Heim
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  4. M Weisser
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  6. A Tichelli
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  7. J Passweg
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  8. A Gratwohl
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Correspondence to C Arber.

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Arber, C., Buser, A., Heim, D. et al. Septic polyarthritis with Ureaplasma urealyticum in a patient with prolonged agammaglobulinemia and B-cell aplasia after allogeneic HSCT and rituximab pretreatment. Bone Marrow Transplant 40, 597–598 (2007). https://doi.org/10.1038/sj.bmt.1705766

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