Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Rituximab treatment may disturb the normal pattern of lymphopoiesis after cord blood SCT

Bone Marrow Transplantation volume 47, pages 458–460 (2012)Cite this article

Detection of abnormal maturation patterns is one of the most commonly used phenotypic criteria to identify B-cell leukemic cells after chemotherapy or SCT. We report two patients who underwent allo-cord blood SCT following the same protocol, and presented immature lymphoid cells in a BM smear with an abnormal maturation pattern shortly after, which led to suspicion of relapse. The transplant protocol included a conditioning regimen with thiotepa 10 mg/kg, fludarabine 150 mg/m2 and i.v. busulfan 9.6 mg/kg. GVHD prophylaxis included anti-thymocyte globulin 6 mg/kg, CYA and mycophenolate mofetil.1

Patient 2 was a 24-year-old woman diagnosed with B-cell ALL with normal karyotype and no molecular markers. The patient achieved first CR after standard therapy,2 and was considered a candidate for SCT because of persistent minimal residual disease by flow cytometry after consolidation therapy (CD10+, CD19+, CD20−, CD34low+, CD45+, TdT low+). She received a single cord blood unit (6/6 Ag-matched, male) at day 0 (1.6 × 105/kg of CD34+ cells, 3.7 × 107/kg of total nucleated cells). At day +16, she presented with EBV reactivation, which was treated with two weekly doses of rituximab (375 mg/m2) with good response. She presented with neutrophil recovery (>0.5 × 109/L) at day +20 and was discharged at day +27. A BM smear at day +48 showed 8% lymphoid blasts with an abnormal phenotype (CD10+, CD19+, CD20−, CD34+, CD45+, TdT low+) similar to diagnosis. As she had full-donor chimerism and had no other analytical or clinical signs of relapse, no therapeutic intervention was performed. A second BM aspirate was performed 3 weeks later showing only 4% immature cells with a normal expression pattern, except for abrogation of CD20. The patient is now 20 months after SCT and continues in CR without evidence of GVHD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Sanz J, Montesinos P, Saavedra S, Lorenzo I, Senent L, Planelles D et al. Single-unit umbilical cord blood transplantation from unrelated donors in adult patients with chronic myelogenous leukemia. Biol Blood Marrow Transplant 2010; 16: 1589–1595.

    Article  PubMed  Google Scholar 

  2. Ribera JM, Oriol A, Bethencourt C, Parody R, Hernández-Rivas JM, Moreno et al. Comparison of intensive chemotherapy, allogeneic or autologous stem cell transplantation as post-remission treatment for adult patients with high-risk acute lymphoblastic leukemia. Results of the PETHEMA ALL-93 trial. Haematologica 2005; 90: 1346–1356.

    CAS  PubMed  Google Scholar 

  3. Robin M, Sanz GF, Ionescu I, Rio B, Sirvent A, Renaud M et al. Unrelated cord blood transplantation in adults with myelodysplasia or secondary acute myeloblastic leukemia: a survey on behalf of Eurocord and CLWP of EBMT. Leukemia 2011; 25: 75–81.

    Article  CAS  PubMed  Google Scholar 

  4. Rénard C, Barlogis V, Mialou V, Galambrun C, Bernoux D, Goutagny MP et al. Lymphocyte subset reconstitution after unrelated cord blood or bone marrow transplantation in children. Br J Haematol 2011; 152: 322–330.

    Article  PubMed  Google Scholar 

  5. Ishikawa F, Livingston AG, Minamiguchi H, Wingard JR, Ogawa M . Human cord blood long term engrafting cells are CD34+ CD38−. Leukemia 2003; 17: 960–964.

    Article  CAS  PubMed  Google Scholar 

  6. Jerez A, Osma M, Castilla-Llorente C, Bernal A, Palacios S, Heras I et al. Transient bone marrow lymphoproliferation after umbilical cord blood transplantation: in adult exacerbated reconstitution of B cell ontogeny. Am J Hematol 2011 (e-pub ahead of print; doi:10.1002/ajh.22013).

  7. Sanchez J, Serrano J, Gomez P, Martínez F, Martín C, Madero L et al. Clinical value of immunological monitoring of minimal residual disease in acute lymphoblastic leukaemia after allogeneic transplantation. Br J Hematol 2002; 116: 686–694.

    Article  Google Scholar 

  8. Reid AG, De Melo VA, Elderfield K, Clark I, Marin D, Apperley J et al. Phenotype of blasts in chronic myeloid leukemia in blastic phase-analysis of bone marrow trephine biopsies and correlation with cytogenetics. Leuk Res 2009; 33: 418–425.

    Article  PubMed  Google Scholar 

  9. Brunstein CG, Weisdorf DJ, DeFor T, Barker JN, Tolar J, van Burik JA et al. Marked increased risk of Epstein-Barr virus-related complications with the addition of antithymocyte globulin to a nonmyeloablative conditioning prior to unrelated umbilical cord blood transplantation. Blood 2006; 108: 2874–2880.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ram R, Ben-Bassat I, Shpilberg O, Polliack A, Raanani P . The late adverse events of rituximab therapy--rare but there. Leuk Lymphoma 2009; 50: 1083–1095.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Dr Miguel Ortin for his critical review of the manuscript.

Author information

Authors and Affiliations

  1. Hematology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    P Barba, L Gallur & D Valcárcel

  2. Hematology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    I Garcia-Cadenas, J Nomdedéu & R Martino

Authors
  1. P Barba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I Garcia-Cadenas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Nomdedéu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Martino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L Gallur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D Valcárcel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Barba.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barba, P., Garcia-Cadenas, I., Nomdedéu, J. et al. Rituximab treatment may disturb the normal pattern of lymphopoiesis after cord blood SCT. Bone Marrow Transplant 47, 458–460 (2012). https://doi.org/10.1038/bmt.2011.98

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2011.98

Search

Advanced search

Quick links