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Intrathecal rituximab for EBV-associated post-transplant lymphoproliferative disorder with central nervous system involvement unresponsive to intravenous rituximab-based treatments: a prospective study

Bone Marrow Transplantation volume 51, pages 456–458 (2016)Cite this article

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EBV-associated post-transplant lymphoproliferative disorder (PTLD) is a lift-threatening complication in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT).1, 2 The incidence of PTLD ranges from 0.2 to 22% in allo-HSCT recipients, depending on the number of risk factors.3, 4 Although the introduction of rituximab as a first-line treatment has improved outcome of PTLD, PTLD with central nervous system (CNS-PTLD) involvement still has a dismal prognosis because of low penetrance of rituximab across the blood-brain barrier.5, 6, 7 In this prospective study, we reported the successful treatment with intrathecal rituximab in CNS-PTLD who had failed to respond to the IV rituximab-based treatments.

From June 2009 to November 2013, 32 cases of EBV-associated PTLD were recorded in the Southern Medical University Institute of Hematology. Fourteen patients diagnosed with CNS-PTLD were enrolled in this prospective study, including 10 peripheral PTLD accompanying with CNS involvement and four primitive CNS-PTLD, at a median time of 60 (29–186) days after allo-HSCT. Antithymocyte globulin was used in 10 patients undergoing HLA-mismatched or unrelated donor transplantation and 3 patients with severe aplastic anemia. Most of the peripheral PTLD with CNS involvement patients (n=9) initially presented with systemic signs and symptoms, such as fever and lymphadenectasis, followed by CNS manifestations within 1 week. The manifestations of primitive CNS-PTLD were fever and CNS presentations, including headache, hyperspasmia, memory impairment and light coma. The characteristics of the 14 patients with CNS-PTLD are summarized in Table 1.

Table 1 Characteristics of the 14 CNS-PTLD
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Acknowledgements

The study was supported by grants from the National Natural Science Foundation of China (No. 81000231, No. 81270647 and No. 81400141), the National Public Health Grand Research Foundation of China (No. 201202017), the Natural science foundation of Guangdong province (No. S2012010009299) and Foundation of President of Nanfang Hospital (No. 2013Z004). We thank Professor Chunrong Tong for providing EBV-CTLs from Beijing Daopei Hospital and Professor Mohamad Mohty from Saint-Antoine Hospital for editing and revising of this paper.

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  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    M Wu, J Sun, Y Zhang, F Huang, H Zhou, Z Fan, L Xuan, G Yu, X Guo, M Dai, R Feng & Q Liu

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  1. M Wu
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Correspondence to Q Liu.

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Wu, M., Sun, J., Zhang, Y. et al. Intrathecal rituximab for EBV-associated post-transplant lymphoproliferative disorder with central nervous system involvement unresponsive to intravenous rituximab-based treatments: a prospective study. Bone Marrow Transplant 51, 456–458 (2016). https://doi.org/10.1038/bmt.2015.281

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