a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA.
b Division of Biostatistics, Mayo Clinic , Scottsdale , AZ , USA.
Leuk Lymphoma. 2019 Jan;60(1):110-117. doi: 10.1080/10428194.2018.1459603. Epub 2018 Jul 6.
Epstein-Barr virus (EBV) reactivation is an unresolved medical issue after allogeneic hematopoietic stem cell transplantation (HSCT). Rituximab treatment is recommended for EBV reactivation after HSCT but the number of doses of rituximab to use is unclear. In this study, risk factors and outcomes of patients who needed 1 dose vs >1 doses of preemptive rituximab to clear EBV viremia were compared. A higher viral load was more likely to be associated with higher doses of rituximab. Patients whose EBV viremia cleared with 1 dose of rituximab were more likely to have a preceding reduction of immunosuppression. Overall survival (OS) in these 2 cohorts was not different (18.7 vs 26.6 months, respectively, p = .96). Since rituximab can have side effects and is fairly costly, a predictive model to determine the number of rituximab doses using viral load would be a useful and cost-effective manner to utilize rituximab for this indication.
标题：同种异体造血干细胞移植后 EBV 再激活的治疗剂量：单剂量与多剂量利妥昔单抗的比较
摘要：背景：同种异体造血干细胞移植（HSCT）后 EBV 再激活是一个未解决的医学问题。推荐在 HSCT 后使用利妥昔单抗治疗 EBV 再激活，但使用的利妥昔单抗剂量尚不清楚。本研究比较了需要 1 剂 vs >1 剂利妥昔单抗清除 EBV 血症的患者的危险因素和结局。
我们回顾性分析了 2008 年 1 月至 2019 年 1 月期间在我们机构接受治疗的所有接受同种异体 HSCT 的患者。所有患者均接受了抗 EBV 预防性治疗，包括 EBV 载量监测和利妥昔单抗治疗。
共有 142 例患者接受了利妥昔单抗治疗，其中 84 例（60%）患者需要 1 剂，58 例（40%）患者需要 >1 剂。多因素分析显示，高病毒载量（HR 2.62，95%CI 1.26-5.45，p = 0.01）和高白细胞计数（HR 2.34，95%CI 1.07-5.12，p = 0.03）与需要多剂量利妥昔单抗相关。需要多剂量利妥昔单抗的患者的 EBV 清除率低于需要 1 剂利妥昔单抗的患者（65% vs 82%，p = 0.01）。需要多剂量利妥昔单抗的患者的总生存（OS）率低于需要 1 剂利妥昔单抗的患者（18.7 个月 vs 26.6 个月，p = 0.07）。
病毒载量和白细胞计数可以预测患者需要使用多少剂量的利妥昔单抗来清除 EBV 血症。需要多剂量利妥昔单抗的患者的 EBV 清除率和 OS 率较低，因此需要更密切的监测和治疗。
