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. 2022 Aug 31:13:967026.
doi: 10.3389/fimmu.2022.967026. eCollection 2022.

The impact of Rituximab administered before transplantation in patients undergoing allogeneic hematopoietic stem cell transplantation: A real-world study

Xiya Wei  1   2 , Yiyu Xie  1   3 , Ruoyu Jiang  1   2 , Huiyu Li  1   2 , Heqing Wu  1   2 , Yuqi Zhang  1   2 , Ling Li  1   2 , Shiyuan Zhou  1   2 , Xiao Ma  1   2 , Zaixiang Tang  4 , Jun He  1   2 , Depei Wu  1   2 , Xiaojin Wu  1   2
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The impact of Rituximab administered before transplantation in patients undergoing allogeneic hematopoietic stem cell transplantation: A real-world study

Xiya Wei et al. Front Immunol. .

Abstract

Rituximab is used to eliminate B cells as a chimeric monoclonal antibody directed against CD20, a B-cell antigen expressed on B cells. To explore the impact of rituximab administered before transplantation, we implemented a retrospective, monocentric study and utilized real-world data collected at our center between January 2018 and December 2020, and then followed until December 2021. Based on whether a dose of 375mg/m2 rituximab was used at least once within two weeks before transplantation, patients undergoing allo-HSCT were classified into two groups: rituximab (N=176) and non-rituximab (N=344) group. Amongst all the patients, the application of rituximab decreased EBV reactivation (P<0.01) and rituximab was an independent factor in the prevention of EBV reactivation by both univariate and multivariate analyses (HR 0.56, 95%CI 0.33-0.97, P=0.04). In AML patients, there were significant differences in the cumulative incidence of aGVHD between the two groups (P=0.04). Our data showed that rituximab was association with a decreased incidence of aGVHD in AML patients according to both univariate and multivariate analyses. There was no difference between the two groups in other sets of populations. Thus, our study indicated that rituximab administered before transplantation may help prevent EBV reactivation in all allo-HSCT patients, as well as prevent aGVHD in AML patients after allo-HSCT.

Keywords: B cell; EBV - Epstein-Barr virus; aGVHD: acute graft vs host disease; allogeneic hematopoietic stem cell transplantation; prior to transplantation; rituximab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Recovery of neutrophils between rituximab and non-rituximab groups. (A) The cumulative incidence of neutrophil engraftment in entire patient cohort. There was no difference in the cumulative incidence of neutrophil engraftment rituximab and non- rituximab groups in entire patient cohort (P= 0.75). (B) The cumulative incidence of neutrophil engraftment in positive anti-HLA antibody group. There was no difference in the cumulative incidence of neutrophil engraftment between 2 groups in positive antibody group (P= 0.36). (C) The cumulative incidence of neutrophil engraftment in patients with negative anti-HLA antibody group. There was not different between 2 groups in the cumulative incidence of neutrophil engraftment in patients with negative anti- HLA antibody (P= 0.45).
Figure 2
Figure 2
Recovery of platelets between rituximab and non-rituximab groups. (A) The cumulative incidence of platelets engraftment in entire patient cohort. There was no difference in the cumulative incidence of platelets engraftment rituximab and non- rituximab groups in entire patient cohort (P= 0.11). (B) The cumulative incidence of platelet engraftment in positive anti-HLA antibody group. There was no difference in the cumulative incidence of neutrophil engraftment between 2 groups in positive antibody group (P= 0.75). (C) The cumulative incidence of platelet engraftment in patients with negative anti-HLA antibody group. There was significantly between 2 groups in the cumulative incidence of platelet engraftment in patients with negative anti- HLA antibody (P,0.01).
Figure 3
Figure 3
Infection of the entire cohort between two groups. (A) The cumulative incidence of CMV in entire patient cohort. There was no difference in the cumulative incidence of CMV between rituximab and non- rituximab groups in entire patient cohort (P= 0.95). (B) The cumulative incidence of EBV in entire patient cohort. There was comparable in the cumulative incidence of EBV between 2 groups in entire patient cohort (P < 0.01).
Figure 4
Figure 4
The cumulative incidence of aGVHD between rituximab and non-rituximab groups in different sets of populations. (A) The cumulative incidence of aGVHD in entire patient cohort. There was no difference in the cumulative incidence of aGVHD between rituximab and non-rituximab in entire patient cohort (P = 0.20). (B) The cumulative incidence of aGVHD in AML patients. There was comparable between 2 groups in the cumulative incidence of aGVHD in AML patients (P = 0.04).
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