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Increased Infection Rate After Preemptive Rituximab Treatment for Epstein-Barr Virus Reactivation After Allogeneic Hematopoietic Stem-Cell Transplantation

2012; Wolters Kluwer; Volume: 94; Issue: 8 Linguagem: Inglês

10.1097/tp.0b013e3182664042

1534-6080

Anna D. Petropoulou, Raphaël Porcher, Régis Peffault de Latour, Aliénor Xhaard, Daniel Weisdorf, Patricia Ribaud, Paula Rodríguez‐Otero, F. Agbalika, Alexis Talbot, Antoine Toubert, Hélène Moins‐Teisserenc, Maryvonnick Carmagnat, Gèrard Socié, Marie Robin,

Lymphoma Diagnosis and Treatment

Preemptive rituximab (R) treatment decreases the incidence of Epstein-Barr virus (EBV) posttransplantation lymphoproliferative disease, but the extent of immune deficiency related to R in patients who received allogeneic hematopoietic stem-cell transplantation is unclear. The aim of our study was to evaluate the incidence of late infections and immune reconstitution after preemptive R treatment of EBV infection.Seventy-eight patients receiving preemptive R between January 2005 and January 2010 were studied. Fifty-two of them could be matched with controls (not receiving R) according to administration of antithymoglobulin, stem-cell source and donor type, age and grade of acute graft-versus-host disease.Among the 78 patients with EBV reactivation treated with R, the 36-month cumulative incidence of bacterial, viral, and fungal infections was 64%, 59%, and 23%, respectively. When compared with controls, bacterial infection incidence was significantly higher in R patients (55% vs. 35%), and a slower reconstitution of B cells was observed. R patients had modest but not significantly higher nonrelapse mortality (35% vs. 15%) than controls.R has dramatically decreased risks of posttransplantation lymphoproliferative disease but is followed by a prolonged and profound B-cell deficiency associated with an excess risk of bacterial infection and higher mortality. R should be given with caution, and immunoglobulin replacement should be provided to limit these excess risks.