Rituxan for EBV reactivation – pro
Most cases of serious EBV reactivation arise in donor- or recipient-derived B cells, one strategy for prevention and treatment is to eliminate EBV-infected B cells. This , of course, eliminates all B cells, infected as well as the non-infected. The most widely used antibody is rituximab, a chimeric murine/human monoclonal anti-CD20 antibody. Prophylaxis and treatment approaches of EBV-PTLD include: administration of rituximab (anti-CD20 monoclonal antibodies), reduction of immunosuppression (RI), EBV-CTL, donor lymphocyte infusion (DLI) and chemotherapy. RI is defined as a sustained decrease of at least 20% of the daily dose of immunosuppressive drugs with the exception of low-dose corticosteroid therapy.21
Pooling results from published studies in HSCT recipients suggest that administration of rituximab results in a positive outcome for approximately 90% patients treated pre-emptively, and 65% with EBV-PTLD. Recent data demonstrate that RI, when applied in combination with rituximab, appears to improve the outcome by over 80%.3 RI used alone as preemptive therapy resulted in a 68% success rate.
Sixth European Conference on Infections in Leukemia (ECIL-6) in 2016 recommends preventative rituximab treatment.
Helen E. Heslop, How I treat EBV lymphoproliferation. November 5, 2009; Blood: 114 (19)
Choquet S, Oertel S, Leblond V, et al. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol 2007;86(8):599-607
Cincinnati Children’s Hospital Medical Center. Evidence based clinical practice guideline for management of EBV-associated post-transplant lymphoproliferative disease (PTLD) in solid organ transplant. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2012 Jan.2010; 2(2)
Jan Styczynski et al, Management of Epstein-Barr Virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European Conference on Infections in Leukemia (ECIL-6) guidelines. Haematologica. 2016 Jul; 101(7): 803811.