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Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3137-3147
Anti-B-Cell Monoclonal Antibody Treatment of Severe Posttransplant
B-Lymphoproliferative Disorder: Prognostic Factors and Long-Term
Outcome
Malika Benkerrou,
Jean-Philippe Jais,
Véronique Leblond,
Anne Durandy,
Laurent Sutton,
Pierre Bordigoni,
Jane Luce Garnier,
Jérôme Le Bidois,
Françoise Le Deist,
Stéphane Blanche, and
Alain Fischer
From the Department of Pediatric Immunology, Biostatistics, Pediatric
Cardiology, Unité Inserm U429, Hôpital Necker Enfants
Malades, Paris; the Department of Hematology, Hôpital de la
Pitié Salpétrière, Paris; the Department of
Hematology, Hôpitaux de Brabois, Nancy; and the Department
of Nephrology, Hôpital Edouard Herriot, Lyon,
France.
B-lymphoproliferative disorder (BLPD) is a rare but severe
complication of organ and bone marrow transplantation (BMT). Profound cytotoxic T-cell deficiency is thought to allow the outgrowth of
Epstein-Barr virus-transformed B cells. When possible, reduction of
immunosuppressive treatment or surgery for localized disease may cure
BLPD. Therapeutic approaches using chemotherapy or antiviral drugs have
limited effects on survival. Adoptive immunotherapy with donor T-cell
infusions has given promising results in BMT recipients. We previously
reported that administration of two monoclonal anti-B-cell antibodies
(anti-CD21 and anti-CD24) could contribute to the control of
oligoclonal BLPD. Here we report the long-term results of treatment
with these monoclonal anti-B-cell antibodies for cases of severe BLPD.
In an open multicenter trial, 58 patients in whom aggressive B-cell
lymphoproliferative disorder developed after BMT (n = 27) or organ (n
= 31) transplantation received 0.2 mg/kg/d of specific anti-CD21 and
anti-CD24 murine monoclonal antibodies (MoAbs) for 10 days. The
treatment was well tolerated. Thirty-six of the 59 episodes of BLPD in
the 58 patients presented complete remission (61%). The
relapse rate was low (3 of 36, 8%). Multivariate analysis identified
the following risk factors for partial or no response to anti-B-cell
MoAb therapy: multivisceral disease (P  .005), central
nervous system involvement (P .05), and late onset of BLPD
(P .005). The overall long-term survival was 46% (median
follow-up, 61 months); it was lower among BMT patients (35%) than
organ transplant patients (55%). None of the patients who had received
BMT for hematological malignancy survived for 1 year. Eight of these 11 patients presented monoclonal BLPD. Tumor burden was the only other
variable that contributed significantly to poor survival. Thus, as
assessed from this long-term study, the use of anti-B-cell MoAbs
therefore appears to be a safe and relatively effective therapy for
severe posttransplant BLPD.
© 1998 by The American Society of Hematology.
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