1601. Effect of Preemptive Rituximab Therapy on Epstein-Barr reactivation in Allogenic Hematopoietic Stem Cell Pediatric Transplants
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • POSTerGaudCATHO.pdf (1.2 MB)
  • Background:

    Children with Epstein-Barr virus (EBV) viremia after hematopoietic stem cell transplantation (HSCT) are at increased risk of post-transplant lymphoproliferative disease (PTLD). Our aim was to assess whether pre-emptive rituximab reduced EBV-viral load (EBV-VL) and the risk of developing PTLD.

    Methods:

    We retrospectively included all children who had a positive EBV-VL within 12 months after an allogenic HSCT (2007-2015) in a single tertiary pediatric hospital. Whole blood EBV-VL was monitored weekly using a real time PCR, during the first 100 days after HSCT and then monthly until 6 months post-HSCT or until EBV-VL became undetectable. EBV-VL clearance was defined as 2 negative EBV-VL at least 1 week apart. Pre-emptive rituximab was defined as a treatment administered before the occurrence of PTLD. We determined the impact of pre-emptive rituximab on EBV-VL clearance, using a marginal structural cox model, adjusting for age at transplant, time between transplant and first positive EBV-VL, in-vivo T-cell depletion at induction, value of EBV-VL at the first dose of rituximab, and the EBV-VL value at the current and previous time point.

    Results:

    Of 214 children who underwent allogenic HSCT, EBV DNA was detected in 87 (41%) children. Children who received rituximab after diagnosis of PTLD were excluded, leading to a cohort of 78 children. Twenty-two (28%) children received pre-emptive rituximab. Mean (SD) age was similar in both groups (10 [5] year). First post-transplant positive EBV-VL was earlier in the pre-emptive rituximab group (mean of 55 [54] vs 113 [96] days; p<0.05) and first positive EBV-VL was higher in the pre-emptive rituximab group (mean of 3.4 [0.6] versus 3.0 [0.6] log10/mL; p<0.05). In adjusted analyses, pre-emptive rituximab was associated with a higher likelihood of EBV-VL clearance (hazard ratio 1.86; 95% confidence interval 1.10-3.14; figure 1). Of the 10 children who developed PTLD, none had received pre-emptive rituximab.

    Conclusion:

    EBV viremia is frequent in children with allogenic HSCT. Our results suggest that pre-emptive rituximab is associated with more rapid EBV-VL clearance. The effect of rituximab on the risk of PTLD needs to be better defined.

    Figure 1: Inverse probability of EBV viremia clearance in children

    Gaud Catho, MD1,2, Daniel Scheel, MSc3, Pierre Teira, MD, MSc4, Christian Renaud, MD, MSc, FRCPC1,5, Lisa Kakinami, PhD3, Philippe Ovetchkine, MD, MSc1 and Julie Autmizguine, MD, MSc, FRCPC1,6,7, (1)Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, (2)Infectious Diseases, Geneva University Hospital-University of Geneva, Geneva, Switzerland, (3)Department of Mathematics and Statistics, Concordia University, Montreal, Montreal, QC, Canada, (4)Onco-Hematology Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, (5)Microbiology and Immunology, CHU Sainte-Justine- Université de Montréal, Montréal, QC, Canada, (6)Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada, (7)Research Center, CHU Sainte-Justine - Université de Montréal, Montreal, QC, Canada

    Disclosures:

    G. Catho, None

    D. Scheel, None

    P. Teira, None

    C. Renaud, None

    L. Kakinami, None

    P. Ovetchkine, None

    J. Autmizguine, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.