Information de reference pour ce titreAccession Number: | 00007890-200904270-00021.
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Author: | Ahmad, Imran 1,4; Cau, Nguyen V. 1; Kwan, John 1; Maaroufi, Younes 2; Meuleman, Nathalie 1; Aoun, Mickael 3; Lewalle, Philippe 1; Martiat, Philippe 1; Crokaert, Francoise 2; Bron, Dominique 1
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Institution: | (1)Department of Clinical Hematology, Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium. (2)Centre de diagnostic moleculaire, Laboratoire Porte de Hal Bordet St-Pierre, Brussels, Belgium. (3)Department of Infectious Diseases, Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium.
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Title: | |
Source: | Transplantation. 87(8):1240-1245, April 27, 2009.
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Abstract: | Background. Epstein-Barr virus (EBV) reactivation after hematopoietic stem-cell transplantation can lead to posttransplant lymphoproliferative disease (PTLD), which carries a high mortality rate. Among therapeutic and prophylactic options being developed, B-cell depletion with monoclonal antibodies is encouraging. Because viral load after transplantation is correlated with PTLD occurrence, we developed a preemptive attitude based on polymerase chain reaction (PCR)-guided rituximab administration.
Methods. We monitored 115 transplant patients with a quantitative PCR for EBV DNA performed on whole-blood samples. Criteria for treatment initiation were a single PCR above 40,000 DNA genome copies per milliliter (gCop/mL) or two rising values above 10,000 gCop/mL. Weekly rituximab infusion at the dose of 375 mg/m2 was administered until negative PCR results were available. We evaluated the incidence of EBV reactivation and PTLD development.
Results. Nineteen patients (16.5%) met the criteria for treatment. Incidence of reactivation was the same in high-risk and standard-risk patients (12 vs. 7, P=0.38). One patient developed PTLD after discontinuation of therapy due to a serious adverse event. No other serious adverse events were noticed. Viral load disappeared after a median of three cycles of therapy, and weekly monitoring allowed prompt intervention. No PTLD-related death was observed, all-cause mortality in the treated population was 68%.
Conclusions. Our PCR-guided and rituximab-based preemptive approach to avoid PTLD after allogeneic hematopoietic stem-cell transplantation is feasible but probably overtreated patients. Prospective trials are strongly needed, they should use uniform PCR techniques and consider higher threshold values for treatment initiation.
(C) 2009 Lippincott Williams & Wilkins, Inc.
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Author Keywords: | Hematopoietic stem-cell transplantation; Epstein-Barr virus; Posttransplant lymphoproliferative disease.
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Language: | English.
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Document Type: | Clinical and Translational Research.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0041-1337
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NLM Journal Code: | wej, 0132144
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DOI Number: | https://dx.doi.org/10.1097/TP.0b...- ouverture dans une nouvelle fenêtre
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