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Pediatric Transplants

Delay in B-lymphocyte recovery and function following rituximab for EBV-associated lymphoproliferative disease early post-allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 43, pages 679–684 (2009)Cite this article

Abstract

Treatment with rituximab is highly effective for EBV-associated post transplant lymphoproliferative disease. However, little is known about its immunological sequelae in pediatric allogeneic hematopoietic SCT (HSCT). Time to normal CD19+ B-lymphocyte values in blood and intravenous immunoglobulin (IVIG) substitution needed to maintain an IgG>400 mg per 100 ml in six consecutive pediatric allogeneic HSCT patients treated with rituximab for symptomatic EBV reactivation were compared with a matched cohort of non-rituximab-treated patients. Follow-up of the six patients ranged from 149 to 1546 days; all but one survived. The mean (±s.d.) time to recovery of CD19+ B-lymphocytes was 353±142 days as compared with 139±42 in the controls (P<0.01). Similarly, substitution of IVIG as a measure of functional B-cell recovery was extended from a mean of 122±45 to a mean of 647±320 days, and the cumulative dose of IVIG increased from a mean of 1.86±0.51 to 4.4±0.97 g/kg, respectively (P<0.05). One patient had functional B-lymphocyte deficiency for >3 years and ultimately required two stem cell boosts. Rituximab is a live-saving treatment for pediatric HSCT patients but may lead to prolonged and even persistent B-cell deficiency.

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Acknowledgements

We thank Claudia Katerkamp, Hedwig Kolve and Maria Waeltermann for administrative and technical support. The results of this analysis were presented at the 25th annual meeting of the European Society for Paediatric Infectious Diseases, Porto, Portugal, 2–4 May 2007.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany

    K Masjosthusmann, K Ehlert, H Juergens, M Fruehwald & A H Groll

  2. Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany

    K Masjosthusmann & J Roth

  3. Department of Medical Microbiology, University Hospital Muenster, Muenster, Germany

    B R Eing

  4. Department of Surgical Pathology, University Hospital Muenster, Muenster, Germany

    G Koehler

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Correspondence to A H Groll.

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Masjosthusmann, K., Ehlert, K., Eing, B. et al. Delay in B-lymphocyte recovery and function following rituximab for EBV-associated lymphoproliferative disease early post-allogeneic hematopoietic SCT. Bone Marrow Transplant 43, 679–684 (2009). https://doi.org/10.1038/bmt.2008.385

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