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Rituximab for posttransplant lymphoproliferative disorder – therapeutic, preemptive, or prophylactic?

Bone Marrow Transplantation volume 59, pages 6–11 (2024)Cite this article

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Abstract

To minimize mortality due to posttransplant lymphoproliferative disorder (PTLD), the following strategies have been used: (1) Therapy without EBV Monitoring, i.e., administration of rituximab after PTLD diagnosis, usually by biopsy, in the absence of routine Epstein–Barr virus (EBV) DNAemia monitoring, (2) Prompt Therapy, i.e., monitoring EBV DNAemia, searching for PTLD by imaging when the DNAemia has exceeded a pre-specified threshold, and administration of rituximab if the imaging is consistent with PTLD, (3) Preemptive Therapy, i.e., monitoring EBV DNAemia and administration of rituximab when the DNAemia has exceeded a pre-specified threshold, and (4) Prophylaxis, i.e., administration of rituximab to all transplant recipients. The superiority of one of these strategies over the other strategies has not been established. Here we review the pros and cons of each strategy. Preemptive therapy or prophylaxis may currently be preferred for patients who are at a high risk of dying due to PTLD. However, Therapy without EBV Monitoring may be used for both high- and low-risk patients in the future, if effective and relatively non-toxic therapies for rituximab-refractory PTLD (e.g., EBV-specific T cells) have become easily available.

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Authors and Affiliations

  1. University of Calgary, Calgary, AB, Canada

    Jan Storek

  2. Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Julian Lindsay

  3. National Centre for Infection in Cancer and Transplantation, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Julian Lindsay

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Storek, J., Lindsay, J. Rituximab for posttransplant lymphoproliferative disorder – therapeutic, preemptive, or prophylactic?. Bone Marrow Transplant 59, 6–11 (2024). https://doi.org/10.1038/s41409-023-02155-5

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