Les anticorps monoclonaux (AcM) ont été utilisés pour traiter des cancers dès le début des années 1980, en particulier lors du travail pionnier de l’équipe de Ronald Levy dans le traitement des lymphomes. Ces traitements ont pendant longtemps été considérés comme une sérothérapie passive à effet immédiat et à court terme. Cependant, au cours de ces dernières années, le concept d’un effet « vaccinal » des anticorps à usage thérapeutique en oncologie a peu à peu vu le jour du fait de réponses cliniques à long terme observées chez certains patients et de différentes études précliniques. En 2010, notre équipe a démontré que des souris immunocompétentes injectées avec les cellules tumorales EL4-huCD20 et traitées avec un AcM anti-huCD20 générait une réponse immunitaire anti-tumorale à long-terme par le biais de mécanismes dépendants de la région constante de l’anticorps et de lymphocytes T CD4+. Mon travail de thèse a donc porté sur l’analyse des mécanismes cellulaires et moléculaires par lesquels le traitement par un AcM anti-CD20 génère une immunité cellulaire adaptative anti-tumorale. J’ai ainsi pu montrer que le traitement des souris avec l’AcM anti-CD20 conduit à une expansion de lymphocytes Th1 producteurs d’IFN-γ, à l’apparition de lymphocytes T CD4+ effecteurs mémoires spécifiques des cellules tumorales CD20+, et au blocage de l’expansion de lymphocytes Tregs induite par les cellules tumorales. Le rôle central dans la protection anti-tumorale et la genèse d’une réponse adaptative anti-tumorale joué par l’axe IL-12/IFN-γ et leurs principales sources cellulaires, cellules dendritiques (DCs) et cellules NK, a été démontré par des expériences de neutralisation de ces cytokines, qui provoque une importante diminution du nombre de Th1 spléniques, de déplétion des cellules NK, ainsi que par des analyses phénotypiques qui ont permis d’identifier des DCs activées par le traitement - comme le montre l’expression accrue des molécules de classe II du CMH et de co-stimulation CD80 et CD86 - comme une importante source cellulaire de l’IL-12. Enfin, nous avons pu montrer qu’un variant de l’IL-2, liant préférentiellement le récepteur de l’IL-2By et faiblement le récepteur de l’IL-2aBy exprimé majoritairement par les Tregs, permettait l’obtention d’une protection anti-tumorale accrue d’animaux porteurs de tumeurs et traités par l’AcM anti-CD20. En conclusion, nous avons démontré qu’un contexte immunitaire pro-tumoral façonné par la présence d’une tumeur en développement peut être inversé par le traitement par un anticorps anti-tumoral, aboutissant à un contexte anti-tumoral. Qu’une telle réponse immunitaire adaptative cellulaire puisse être observée chez des patients atteints de lymphomes, traités par un anticorps anti-CD20, reste encore à être déterminé. / Monoclonal antibodies have been used to treat cancers since the early 1980s, in particular with the pioneer work of Ronald Levy for the treatment of lymphomas. Those treatments have been considered for a long time as a passive serotherapy with immediate and short term actions. Yet, recently, the idea of a vaccine effect of therapeutic antibodies in oncology have appeared, after preclinical studies and clinic observations suggesting a long term immune response in patients. In 2010, our team demonstrated that immunocompetent mice injected with EL4-huCD20 tumor cells and treated with anti-huCD20 monoclonal antibody generated a long term anti-tumor immune response linked with mechanisms dependent on constant part of antibodies and CD4+ T cells. My PhD work was based on the analysis of cellular and molecular mechanisms by which the treatment by an anti-CD20 mAb generates a cellar adaptive anti-tumor immunity. I could show that the treatment of mice with anti-CD20 antibody lead to the expansion of Th1 lymphocytes IFN-γ producers, to the apparition of effector memory CD4+ T cells specific for CD20 antigen, and to the blockade of the expansion of Treg cells induced by tumor cells. The key role of an adaptive anti-tumor immune response played by IL-12/IFN- γ and their main cellular sources, dendritic cells and NK cells, in the anti-tumor protection and genesis, has been demonstrated by experiments of cytokine neutralization, provoking an important decrease of splenic Th1 number, by NK depletion and by phenotypic analysis that allowed the identification of DCs activated by the treatment – as it is shown by the increased expression of MHC-II and CD80 and CD86 costimulation molecules, - as an important cellular source of IL-12. Finally, we could show that a variant of IL-2, binding preferentially IL-2By with a lower affinity for the IL-2aBy receptor mainly expressed by Tregs, could induce an increased anti-tumor protection of tumor-bearing animals treated with anti-CD20 mAb. In conclusion, we have demonstrated that a pro-tumor immune contexture affected by a growing tumor can be modified by an anti-tumor antibody leading to an anti-tumor contexture. That such cellular adaptive immune response could be observed in lymphoma patients treated with anti-CD20 still need to be determined.

L’anticorps monoclonal anti-CD20 (Rituximab) est largement utilisé dans le traitement des maladies auto-immunes. L’analyse de la rate des patients souffrant d’un purpura thrombopénique (PTI) ou d’une anémie hémolytique auto-immune traités par anti-CD20 a mis en évidence que la déplétion lymphocytaire B favorisait la différenciation des plasmocytes (PC) normaux en plasmocytes à longue durée de vie (PLDV) auto-réactifs, expliquant en partie l’absence de réponse à ce traitement. L’enjeu de ce projet a été de savoir si la déplétion lymphocytaire B induit l’émergence de PLDV spléniques et de comprendre les processus impliqués dans la survie plasmocytaire. Pour ce faire, nous avons utilisé le modèle de souris transgénique AID-Cre-ERT2xRosa26-loxP-EYFP qui permet de marquer irréversiblement par la protéine EYFP les cellules B lors de leur passage dans un centre germinatif au cours d’une réponse immune après ingestion de tamoxifène, puis de les suivre in vivo. Les PC EYFP+ ont été générés suite à 2 immunisations avec des globules rouges de mouton. Après avoir sélectionné un set de gènes permettant d’établir les signatures plasmablastiques et plasmocytaires, nous avons comparé par RT-PCR multiplex sur cellules uniques le profil d’expression des PC EYFP+ de la rate de souris traitées ou non par anti-CD20. Nous avons ainsi caractérisé dans le contexte de déplétion B une population plasmocytaire dans la rate homogène et mature, proche des PLDV de la moelle osseuse. Ce profil était différent de celui retrouvé dans la rate des souris contrôles, plus hétérogène, comprenant une majorité de PC intermédiaires entre plasmablastes et PC matures. Nous avons observé le même processus de différenciation paradoxale plasmocytaire dans la rate sous anti-CD20 dans le modèle murin lupique NZB/W, signifiant probablement un mécanisme général, que ce soit en contexte auto-immun ou non, chez l’homme et chez la souris. Nous avons identifié le BAFF (B-cell activating factor) comme un facteur essentiel dans le processus de survie des PC de la rate dans le contexte de déplétion B. En effet, le taux de BAFF augmente dans le sérum et le tissu splénique après traitement par anti-CD20, la combinaison in vivo des traitements anti-CD20 et anti-BAFF induit une diminution drastique des PLDV de la rate, sans générer d’hypogammaglobulinémie IgG. Les granuleux Gr1+ et en particulier les neutrophiles Ly6G+ semblent être la principale source de production de BAFF dans le contexte de déplétion B. Nous avons observé un effet similaire de la combinaison anti-CD20 et anti-BAFF sur les PLDV de la rate dans le modèle lupique NZB/W. Enfin, les LT CD4+ sont un autre composant important de la niche splénique dans le contexte de déplétion B. En effet, le nombre de PC EYFP+ diminue significativement avec l’association anti-CD20 et anti-CD4. Ces résultats suggèrent donc que l’association du traitement anti-CD20 à un inhibiteur de facteur de survie plasmocytaire spécifique de la rate, en particulier BAFF, pourrait avoir un bénéfice clinique au cours des maladies auto-immunes en interférant sur le processus paradoxal de maturation des PC. Un essai clinique associant les traitements anti-CD20 et anti-BAFF au cours du PTI débutera prochainement. / Previous data suggested that the monoclonal anti-CD20 antibody induced paradoxically the settlement of autoreactive splenic long-lived plasma cells (LLPC) in the spleen of patients with auto-immune cytopenia, explaining the treatment failure. To investigate whether this process had a general relevance and decipher its mechanism, we used the AID-CreERT2-EYFP mouse model, which allows the irreversible expression of EYFP in B cells engaged in an immune response after tamoxifen regimen to follow plasma cells at different times after immunization. When analyzed by multiplex PCR at the single-cell level, while the splenic EYFP+B220-PC of untreated mice displayed an intermediate profile between short-lived and long-lived PC, the PC from anti-CD20 treated mice composed a more mature homogeneous population, similar to the long-lived bone marrow PC. The absolute number of splenic EYFP+B220-PC did not change significantly upon anti-CD20 treatment indicating that B-cell depletion promoted PC differentiation rather than a long-lived PC selection. BAFF (B-cell activating factor) and CD4+ T-cells played a major role in plasma cell survival since combination of anti-CD20 with anti-BAFF or anti-CD4 antibodies dramatically reduced the number of splenic EYFP+B220- LLPC. Anti-CD20 treatment also promoted the differentiation of LLPC in the spleen in the lupus prone NZB/W model, while a treatment combining anti-CD20 with anti-BAFF induced a marked reduction in total splenic PC numbers. These results suggest that the process of PC maturation upon anti-CD20 treatment is a general mechanism and that interfering with anti-BAFF antibody at the time of B-cell depletion might greatly improve the response rate in auto-immune disease.

Les lymphomes B non-Hodgkiniens (LNHB) représentent le type d’hémopathie maligne le plus fréquent. Ces pathologies sont traitées par l’association de chimiothérapies conventionnelles et d’immunothérapies dirigées contre le CD20. Bien qu’efficace, 40% des patients résistent ou rechutent après le traitement. Deux raisons peuvent expliquer ces échecs thérapeutiques : 1) l’absence de cibles thérapeutiques impliquées dans plusieurs processus oncogéniques et 2) l’absence de modèles pré-cliniques de LNHB pertinents pour le test de molécules thérapeutiques et la compréhension de la lymphomagenèse. Le calcium est un messager ubiquitaire qui est impliqué dans de nombreux processus cellulaires en condition physiologique et pathologique. La principale voie d’entrée de calcium dans les lymphocytes B est l’entrée capacitive de calcium médiée par Orai1 et STIM1. Ces deux protéines ont été largement décrites pour être impliquées dans les processus tumoraux de nombreux cancers, cependant leurs rôles dans la lymphomagenèse restait à élucider. Nos travaux ont révélé l'implication de la signalisation calcique dans la mort induite par le GA101, un anti CD20 de nouvelle génération actuellement en essai clinique. De plus, nous avons mis en évidence l’implication des protéines Orai1 et STIM1 dans la migration des cellules cancéreuses de LNHB. De manière intéressante, l’implication de ces deux protéines dans la migration cellulaire est calcium indépendante, suggérant donc un nouveau rôle de ces protéines. Enfin, grâce à la technologie des capsules cellulaires nous avons établi un nouveau modèle 3D de lymphome mimant la niche tumorale en incluant des cellules du microenvironnement et de la matrice extracellulaire. Ce modèle semble particulièrement pertinent pour le screening de molécules et la compréhension des mécanismes de la lymphomagenèse. Ce travail de thèse révèle ainsi le ciblage de Orai1 et STIM1 comme potentiellement intéressant dans le traitement du LNHB. / B-cell non-Hodgkin lymphomas (BNHL) are the most common hematological malignancies, usually treated with a combination of chemotherapy and anti CD20 immunothérapie. However, 40% of patients are resistant or relapse after treatment. These therapeutic failures could be due to 1) lack of therapeutic targets implicated in several oncogenic processes, 2) lack of relevant preclinical BNHL models for drug screening and lymphomagenesis studies. Calcium is an essential second messenger involved in various cell functions. In B cells, calcium entry is mainly due to Orai1 and STIM1 proteins, both of which have been associated with oncogenesis on solid tumors. However, their role in lymphomagenesis still remains to be elucidated. Our work shows that calcium signaling in BNHL cells participates in cell death induced by GA101, a novel anti-CD20 monoclonal antibody. We also demonstrate that Orai1 and STIM1 play a role in BNHL cell migration. Interestingly, both proteins controlled cell migration in a calcium-independent manner, suggesting a new role for these proteins. Finally, using cellular capsule technology, we established a new BNHL 3D model mimicking tumoral niche by including extracellular matrix and stromal cells. This new model could be used for drug screening and understanding lymphomagenesis. In summary, this work suggests that targeting of Orai1 and STIM1 is promising for BNHL treatment.

Les anticorps monoclonaux (AcM) anti-CD20 sont essentiels pour le traitement du lymphome non hodgkinien et de la leucémie lymphoïde chronique (LLC). Les AcM agissent soit en activant directement la signalisation apoptotique dans les cellules cibles, soit via le système immunitaire. Dans une étude préclinique, nous avons montré que le traitement avec AcM anti-CD20, rituximab et GA101, induit l'expression de la protéine early growth response 1 (EGR-1) (Dalle et al., 2011). EGR-1 est un facteur de transcription régulé par le calcium (Ca2+) et CD20 est impliqué dans la régulation du flux calcique transmembranaire. Nous avons donc étudié le rôle d'EGR-1 et du flux Ca2+ dans l'activité cytotoxique des AcM anti-CD20. Nous avons montré qu'EGR-1 est rapidement induit suite à l'exposition au rituximab et à GA101. La baisse de l'expression d'EGR-1 par shRNA a supprimé l'effet cytotoxique du GA101 à la fois in vitro et in vivo, indiquant qu'EGR-1 est requis pour la mort cellulaire médiée par CD20. De plus, la surexpression d'EGR-1 augmente la sensibilité au GA101 in vitro et in vivo. En outre, nos résultats indiquent que les AcM anti-CD20 induisent un flux Ca2+. Le blocage du flux Ca2+ par inhibiteurs de canaux calciques (ICC) a aboli l'induction d'EGR-1 ainsi que l'efficacité du GA101 in vivo et ex vivo dans des échantillons de LLC. Plus important, nos données indiquent que les patients recevant des ICC ont une moins bonne réponse au traitement par les AcM anti-CD20. En conclusion, nous avons identifié EGR-1 comme potentiel biomarqueur pour prédire la réponse à la thérapie anti-CD20 et démontré que les ICC ont un impact négatif sur l'efficacité des AcM anti-CD20 chez les patients / Anti-CD20 monoclonal antibodies (mAbs) are an essential component of the treatment of patients with non-Hodgkin's lymphoma and chronic lymphocytic leukemia (CLL). They mediate their antitumor effects by activating the immune system or by direct apoptotic signaling in target cells. In a previous preclinical study, we showed that treatment with anti-CD20 mAbs, rituximab and GA101, resulted in upregulated expression of early growth factor 1 (EGR-1) (Dalle et al. 2011). EGR-1 is a calcium (Ca2+) regulated transcription factor and CD20 is hypothesized to regulate transmembrane Ca2+ flux. Therefore, we aimed to assess the role of EGR-1 and Ca2+ flux in the cytotoxic activity of anti-CD20 mAbs. We have shown that EGR-1 expression is rapidly upregulated in CD20+ cells following rituximab and GA101 exposure. Decreasing EGR-1 expression by shRNA abolishes the direct cytotoxic effect of GA101 both in vitro and in vivo, indicating that EGR-1 is required for CD20-mediated cell death. Additionally, the overexpression of EGR-1 enhances the cytotoxic activity of GA101 both in vitro and in vivo. Furthermore, our results indicate that anti-CD20 mAbs induce calcium influx. Blocking the Ca2+ flux with calcium channel blockers (CCB) abolishes EGR-1 induction and impaires the GA101 efficacy in vivo and ex vivo in CLL blood samples. More importantly, our data indicate that patients receiving CCBs and anti-CD20 therapy have worst progression free survival and overall survival. In conclusion we have identified EGR-1 as a potential biomarker to predict response to anti-CD20 therapy. We demonstrated that co-treatement with CCBs negatively impacts the outcome of patients receiving anti-CD20 mAbs

A doença linfoproliferativa pós transplante (DLPT) é a proliferação tecidual secundária mais comum em crianças submetidas a transplante de órgãos sólidos, e representa um espectro de proliferação linfoide clínica e morfologicamente heterogêneo que vai desde uma hiperplasia policlonal indolente até linfomas agressivos. Aproximadamente 80% das DLPT estão associadas ao vírus Epstein Barr (EBV) e é originaria de células B, entre 10 a 15% tem origem em células T e aproximadamente 1% em células natural killer. O status sorológico negativo para EBV pré transplante e o grau de imunossupressão são os fatores de risco de maior relevância para o desenvolvimento desta enfermidade. A apresentação clínica é diversa e sintomas constitucionais podem estar presentes simulando infecção e ou rejeição ao órgão transplantado. A confirmação do diagnóstico por exame histopatológico é, habitualmente, necessária e a hibridização in situ geralmente detecta as partículas de EBV nos tecidos examinados. A melhor opção terapêutica ainda não está definida e atualmente o tratamento consiste na redução da imunossupressão associada ao uso do anticorpo Anti CD20 e ou quimioterapia citotóxica além da terapia celular disponível em alguns centros. Este estudo teve por objetivos avaliar a resposta tumoral ao uso do anticorpo Anti CD20 na DLPT de células B EBV positivas pós transplante de órgãos sólidos, além de associar a neoplasia à eventual inclusão genômica de DNA/EBV na célula neoplásica. Foram analisados retrospectivamente os prontuários de vinte e três pacientes com até 18 anos incompletos admitidos na Unidade de Internação do Serviço de Onco- Hematologia do Instituto da Criança (ICR) e Instituto do Tratamento do Câncer Infantil (ITACI) que desenvolveram DLPT CD20 positiva pós transplante de órgãos sólidos comprovada histologicamente entre 8 de março de 1995 e 13 de agosto de 2011. Todos foram submetidos à redução da imunossupressão, treze receberam Anti CD20 isolado, três Anti CD20 associado à quimioterapia citotóxica e sete pacientes não fizeram uso desta droga. A sobrevida global em dois anos dos pacientes que receberam Anti CD20 foi de 81,45% e quando comparada à sobrevida global de 37,5% dos que não receberam a droga revelou diferença estatística significativa (p=0,02). Todos os pacientes tiveram a detecção da proteína de latência viral de EBV Latent Membrane Protein1 (LMP1) na célula tumoral através da técnica de hibridização in situ realizada em blocos de parafina devidamente armazenados ao diagnóstico. A curta duração do tratamento com o Anti CD20, a toxicidade aceitável em relação às demais alternativas terapêuticas, a possibilidade de seu uso exclusivo, sua eficácia inclusive na doença de histologia agressiva e associação às demais alternativas de tratamento na doença refratária sugerem a inclusão desta droga no arsenal terapêutico atualmente disponível / Post-transplant lymphoproliferative disease (PTLD) is the most common secondary tissue proliferation that occurs in children after solid organ transplantation and represents a spectrum of clinical lymphoid proliferation and morphologic heterogeneity that goes from an indolent polyclonal hyperplasia to aggressive lymphomas. Approximately 80% of PTLD is associated with Epstein Barr virus (EBV) and is of B-cell origin, 10 to 15% of T-cells and approximately 1% of natural killer cells. EBV pretransplant seronegativity and the degree of immunosuppression are the most relevant risk factors for developing the disease. Clinical presentation is diverse and constitutional symptoms may simulate infection and/or organ transplanted rejection. Histopathologic examination is usually necessary to confirm diagnosis and, generally, in situ hybridization detects the EBV particles in examined tissues. The best treatment option is yet to be determined and the current treatment consists of immunosuppression reduction associated with the use of anti CD20 antibody and/or cytotoxic chemotherapy besides cell therapy only available in some centers. This study aimed to evaluate tumor response to the use of anti CD20 antibody in positive B-cell EBV PTLD after solid organ transplantation and the association of the neoplasia to the eventual inclusion of genomic EBV/DNA in the tumor cell. We retrospectively analyzed medical records of twenty-three patients under 18 years of age who were admitted to the inpatient unit of Serviço de Onco- Hematologia do Instituto da Criança (ICR) e Instituto do Tratamento do Câncer Infantil (ITACI) who developed histologically proven CD20 positive pediatric PTLD after solid organ transplantation between 8 March 1995 and 13 August 2011. All patients were submitted to immunosuppression reduction, thirteen received isolated Anti CD20, three Anti CD20 associated with cytotoxic chemotherapy and seven patients did not use this drug. The estimated 2-year overall survival rates of patients who received anti CD20 was 81.45% and when compared to the overall survival rates of those who did not receive the drug it was 37, 5%, showing a statistically significant difference (p = 0.02). All patients had the Epstein-Barr virus latency protein (latent membrane protein1 - LMP1) detected in tumor paraffin embedded stored at diagnosis by the in situ hybridization technic. The short duration of the Anti CD20 treatment, its acceptable toxicity compared to other therapeutic alternatives, the possibility of its exclusive use, its effectiveness in aggressive histology disease and the association with other treatment alternatives in refractory disease, suggest this drug inclusion to the currently available therapeutic arsenal

A doença linfoproliferativa pós transplante (DLPT) é a proliferação tecidual secundária mais comum em crianças submetidas a transplante de órgãos sólidos, e representa um espectro de proliferação linfoide clínica e morfologicamente heterogêneo que vai desde uma hiperplasia policlonal indolente até linfomas agressivos. Aproximadamente 80% das DLPT estão associadas ao vírus Epstein Barr (EBV) e é originaria de células B, entre 10 a 15% tem origem em células T e aproximadamente 1% em células natural killer. O status sorológico negativo para EBV pré transplante e o grau de imunossupressão são os fatores de risco de maior relevância para o desenvolvimento desta enfermidade. A apresentação clínica é diversa e sintomas constitucionais podem estar presentes simulando infecção e ou rejeição ao órgão transplantado. A confirmação do diagnóstico por exame histopatológico é, habitualmente, necessária e a hibridização in situ geralmente detecta as partículas de EBV nos tecidos examinados. A melhor opção terapêutica ainda não está definida e atualmente o tratamento consiste na redução da imunossupressão associada ao uso do anticorpo Anti CD20 e ou quimioterapia citotóxica além da terapia celular disponível em alguns centros. Este estudo teve por objetivos avaliar a resposta tumoral ao uso do anticorpo Anti CD20 na DLPT de células B EBV positivas pós transplante de órgãos sólidos, além de associar a neoplasia à eventual inclusão genômica de DNA/EBV na célula neoplásica. Foram analisados retrospectivamente os prontuários de vinte e três pacientes com até 18 anos incompletos admitidos na Unidade de Internação do Serviço de Onco- Hematologia do Instituto da Criança (ICR) e Instituto do Tratamento do Câncer Infantil (ITACI) que desenvolveram DLPT CD20 positiva pós transplante de órgãos sólidos comprovada histologicamente entre 8 de março de 1995 e 13 de agosto de 2011. Todos foram submetidos à redução da imunossupressão, treze receberam Anti CD20 isolado, três Anti CD20 associado à quimioterapia citotóxica e sete pacientes não fizeram uso desta droga. A sobrevida global em dois anos dos pacientes que receberam Anti CD20 foi de 81,45% e quando comparada à sobrevida global de 37,5% dos que não receberam a droga revelou diferença estatística significativa (p=0,02). Todos os pacientes tiveram a detecção da proteína de latência viral de EBV Latent Membrane Protein1 (LMP1) na célula tumoral através da técnica de hibridização in situ realizada em blocos de parafina devidamente armazenados ao diagnóstico. A curta duração do tratamento com o Anti CD20, a toxicidade aceitável em relação às demais alternativas terapêuticas, a possibilidade de seu uso exclusivo, sua eficácia inclusive na doença de histologia agressiva e associação às demais alternativas de tratamento na doença refratária sugerem a inclusão desta droga no arsenal terapêutico atualmente disponível / Post-transplant lymphoproliferative disease (PTLD) is the most common secondary tissue proliferation that occurs in children after solid organ transplantation and represents a spectrum of clinical lymphoid proliferation and morphologic heterogeneity that goes from an indolent polyclonal hyperplasia to aggressive lymphomas. Approximately 80% of PTLD is associated with Epstein Barr virus (EBV) and is of B-cell origin, 10 to 15% of T-cells and approximately 1% of natural killer cells. EBV pretransplant seronegativity and the degree of immunosuppression are the most relevant risk factors for developing the disease. Clinical presentation is diverse and constitutional symptoms may simulate infection and/or organ transplanted rejection. Histopathologic examination is usually necessary to confirm diagnosis and, generally, in situ hybridization detects the EBV particles in examined tissues. The best treatment option is yet to be determined and the current treatment consists of immunosuppression reduction associated with the use of anti CD20 antibody and/or cytotoxic chemotherapy besides cell therapy only available in some centers. This study aimed to evaluate tumor response to the use of anti CD20 antibody in positive B-cell EBV PTLD after solid organ transplantation and the association of the neoplasia to the eventual inclusion of genomic EBV/DNA in the tumor cell. We retrospectively analyzed medical records of twenty-three patients under 18 years of age who were admitted to the inpatient unit of Serviço de Onco- Hematologia do Instituto da Criança (ICR) e Instituto do Tratamento do Câncer Infantil (ITACI) who developed histologically proven CD20 positive pediatric PTLD after solid organ transplantation between 8 March 1995 and 13 August 2011. All patients were submitted to immunosuppression reduction, thirteen received isolated Anti CD20, three Anti CD20 associated with cytotoxic chemotherapy and seven patients did not use this drug. The estimated 2-year overall survival rates of patients who received anti CD20 was 81.45% and when compared to the overall survival rates of those who did not receive the drug it was 37, 5%, showing a statistically significant difference (p = 0.02). All patients had the Epstein-Barr virus latency protein (latent membrane protein1 - LMP1) detected in tumor paraffin embedded stored at diagnosis by the in situ hybridization technic. The short duration of the Anti CD20 treatment, its acceptable toxicity compared to other therapeutic alternatives, the possibility of its exclusive use, its effectiveness in aggressive histology disease and the association with other treatment alternatives in refractory disease, suggest this drug inclusion to the currently available therapeutic arsenal