Aims: To explore a new method for treating failure of rituximab plus immunosuppressant dose reduction in EB virus-related post-transplant lymphoproliferative disorders (PTLD).

Methods: This study retrospectively analyzed the clinical data of 60 patients diagnosed with PTLD at the Institute of Hematology & Blood Diseases Hospital and Chinese Academy of Medical Sciences from May 2017 to June 2024, including confirmed and clinically diagnosed cases. Among them, 22 patients underwent lymph node biopsy, and except for 3 patients whose biopsy specimens were not marked with CD38, the remaining 19 patients had positive CD38, of whom 10/19 were strongly positive. We treated 4 patients with failed rituximab plus immunosuppressant dose reduction therapy (1 case of acute T-cell leukemia, 1 case of acute myeloid leukemia, 1 case of acute B-cell leukemia, and 1 case of Ph+ mixed cell leukemia) with daratumumab.

Results: Of the 4 patients, 3 had obvious disease progression after receiving rituximab 375mg/m2/w twice (EBV-DNA progressively increased to more than 100 times the baseline level or lymph nodes progressively enlarged), and 1 had an initial EBV-DNA level of 107,310 copies/ml, which increased to 354,787 copies/ml after receiving rituximab. All 4 patients received daratumumab 16mg/kg qw 2-4 times, and all patients achieved complete remission (CR). They were followed up for 2.5 to 22.5 months, and all patients were alive and in complete remission from PTLD. 2/4 patients experienced a clear viral infection after receiving the CD38 monoclonal antibody, including one case of widespread adenovirus infection and one case of herpes simplex virus infection in the mouth, nose, and eyes, which improved after treatment.

Conclusion: This study is the first to reveal high expression of CD38 in PTLD and successfully treated 4 patients who failed to reduce their treatment with rituximab and immunosuppressants. Daratumumab may become a new option for the treatment of PTLD patients.

Disclosures

No relevant conflicts of interest to declare.

This content is only available as a PDF.
2024
Sign in via your Institution