Efficacy of rituximab on preventing Epstein-Barr virus infection in aplastic anemia patients after allogeneic hematopoietic stem cell transplantation
Objective To explore the efficacy of low-dose rituximab(RTX)on preventing Epstein-Barr virus(EBV)infection in aplastic anemia(AA)patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to explore its safety.Methods Ninety-one AA patients underwent allo-HSCT in Henan Cancer Hospital from March,2017 to August,2020,and their clinical data were retrospectively analyzed.Among these 91 patients,53 patients received low-dose RTX once on the 5th day after allo-HSCT(RTX group),and the other 38 patients received oral acyclovir(400 mg once,twice a day)from the day before allo-HSCT to the time for termination of immunosuppressant to prevent EBV infection(control group).All patients in two groups received routine treatment to prevent cytomegalovirus infection and graft-versus-host disease(GVHD).The blood routine results,serum immunoglobulin levels,and counts of CD3+and CD20+lymphocytes were recorded on the 30th,60th and 90th days after allo-HSCT.The 3-year follow-up was done to record the occurrences of EBV infection,cytomegalovirus infection,other infections,post-transplant lymphoproliferative disorder,GVHD and survival in two groups.Results(1)There were no significant differences in the count of mononuclears cells reinfused,count of CD34+cells,granulocyte and platelet implantation time,rate of blood reconstruction,and post-transplant incidence of Ⅱ to Ⅳ acute and chronic GVHD between two groups(P＞0.05).(2)The counts of lymphocyte on the 30th,60th and 90th days after allo-HSCT were lower in RTX group[0.2(0.1,0.4)×109/L,0.2(0.1,0.3)×109/L,0.3(0.1,1.5)×109/L]than those in control group[0.5(0,4.1)×109/L,0.6(0.1,2.5)×109/L,1.3(0.3,2.9)×109/L](P＜0.05).The level of IgA on the 30th day after allo-HSCT was lower in RTX group[0.95(0.18,2.29)g/L]than that in control group[1.59(0.77,2.68)g/L](P＜0.05).(3)The follow-up was done till December 31,2023,which showed that the rate of EBV infection,maximum EBV-DNA load and rate of EBV-DNA load＞1 × 104 copy/mL were lower in RTX group[20.75％,9.60(2.20,51.30)× 103copy/mL,9.43％]than those in control group after allo-HSCT[65.79％,36.40(6.60,154.00)× 103 copy/mL,26.32％](P＜0.05).The first-time EBV infection developed later in RTX group[77(36,420)d]than that in control group[33(23,53)d](P＜0.05).There were no significant differences in the EBV-DNA load of the first-time EBV infection,the incidence of post-transplant lymphoproliferative disorder,and the rates of severe infection and cytomegalovirus infection after allo-HSCT between two groups(P＞0.05).There were 9 deaths in RTX group and 11 deaths in control group.The 3-year overall survival rate showed no significant difference between RTX group(82.30％)and control group(70.00％)(P＞0.05).Conclusion The use of low-dose RTX on the 5th day after allo-HSCT can significantly reduce the rate of EBV infection in AA patients,with the mild hypogammaglobulinemia,no influence on blood reconstruction and no increase of other infection rates,and it is safe.
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