Evaluation of the Efficacy of a Treatment by One Single Dose of Rituximab (375mg/m2 ) in the Prevention of the Epstein Barr Virus (EBV) Primary Infection and Post-transplant Lymphoproliferative Disorder in Adult EBV Seronegative Patients Who Received an EBV Seropositive Kidney Allograft

  • STATUS
    Recruiting
  • End date
    Dec 1, 2029
  • participants needed
    120
  • sponsor
    University Hospital, Strasbourg, France
Updated on 4 October 2022

Summary

Epstein Barr virus infects over 90% of human population and persists during lifetime. After infecting B lymphocytes, EBV remains latent in memory B cells. In immunocompromised patients, primary infection could lead to an uncontrolled EBV infected B cells proliferation because of impaired T cell specific cytotoxicity. The latent EBV infection is characterized by expression of restricted latent gene products, which drive cell proliferation and progression to PTLD. As a consequence, EBV seronegativity and EBV mismatch are major risk factors for developing PTLD. The investigators reported in a previous work from the French Registry that the incidence of PTLD was multiplied by ten in adult EBV negative kidney transplant recipients. Moreover, even if the event is relatively rare after transplantation, the prognosis is severe with high morbidity and an overall mortality rate around 50%.

Nowadays, few and inconsistent data exist regarding beneficial preventing strategies like antiviral therapy, reduction of immunosuppression or immunoglobulin infusion in this high-risk population of EBV negative recipients. Therefore, an efficient and safe preventive treatment is still lacking to decrease PTLD incidence.

Rituximab, has been already proposed in stem cell transplant recipients as a preemptive therapy in patients with a persistent EBV viremia independently of their EBV status. A pilot study was performed in EBV negative kidney transplant recipients but in a very small population. Schachtner60 reported the cases of 5 EBV negative recipients receiving kidney from EBV positive donors after a treatment with Rituximab. Only 2 patients showed a seroconversion and no patients developed neither a viremia nor a PTLD after 49 months of follow-up.

The main objective of the investigators study is to evaluate the efficacy of early infusion of Rituximab in the prevention of EBV primary infection and post-transplant lymphoproliferative disorder (PTLD) occurrence in adult EBV negative kidney transplant recipients transplanted with an EBV positive donor.

Details
Condition Epstein-Barr Virus Infections
Treatment Rituximab, Control group
Clinical Study IdentifierNCT04989491
SponsorUniversity Hospital, Strasbourg, France
Last Modified on4 October 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Adult patients (age ≥18 years at transplantation)
Kidney and kidney pancreas simultaneous transplantation
EBV seronegative patients (IgG anti EBNA, IgG anti VCA and IgM anti VCA negative) (from 6 months before transplantation to the day of transplantation, included)
Patient who have given written informed consent
Negative pregnancy test and use of contraception during all the study
EBV positive donor
Patient affiliated to a social security scheme

Exclusion Criteria

Patient with known HBV active infection
Allergy to Rituximab
Severe Immune deficiency
Severe cardiac insufficiency
Pregnant or lactating women
Women of child bearing potential unless they are using a birth control method
Patient under judicial protection or under guardianship
Patient currently participating in another clinical trial investigating drugs. Observational studies are not considered as an exclusion criterion
Any form of substance abuse, psychiatric disorder or condition, which, in the opinion of the investigator, is incompatible with the participation in the study
Unlikely to comply with the visits scheduled in the protocol
Exclusion Criteria
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