Faculty Collaboration Database

Survival outcomes of allogeneic hematopoietic cell transplants with EBV-positive or EBV-negative post-transplant lymphoproliferative disorder, A CIBMTR study. Transpl Infect Dis 2019 Oct;21(5):e13145

Date

07/14/2019

Pubmed ID

31301099

Pubmed Central ID

PMC7239317

DOI

10.1111/tid.13145

Scopus ID

2-s2.0-85073491232 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: Post-transplant lymphoproliferative disorders (PTLD) are associated with significant morbidity and mortality following allogeneic hematopoietic cell transplant (alloHCT). Although most PTLD is EBV-positive (EBV^pos ), EBV-negative (EBV^neg ) PTLD is reported, yet its incidence and clinical impact remain largely undefined. Furthermore, factors at the time of transplant impacting survival following PTLD are not well described.

METHODS: Between 2002 and 2014, 432 cases of PTLD following alloHCT were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). After exclusions, 267 cases (EBV^pos  = 222, 83%; EBV^neg  = 45, 17%) were analyzed.

RESULTS: Two hundred and eight patients (78%) received in vivo T-cell depletion (TCD) with either anti-thymocyte globulin (ATG) or alemtuzumab. Incidence of PTLD was highest using umbilical cord donors (UCB, 1.60%) and lowest using matched related donors (MRD, 0.40%). Clinical features and histology did not significantly differ among EBV^pos or EBV^neg PTLD cases except that absolute lymphocyte count recovery was slower, and CMV reactivation was later in EBV^neg PTLD [EBV^pos 32 (5-95) days versus EBV^neg 47 (10-70) days, P = .016]. There was no impact on survival by EBV status in multivariable analysis [EBV^neg RR 1.42, 95% CI 0.94-2.15, P = .097].

CONCLUSIONS: There is no difference in survival outcomes for patients with EBV^pos or EBV^neg PTLD occurring following alloHCT and 1-year survival is poor. Features of conditioning and use of serotherapy remain important.

Author List

Naik S, Riches M, Hari P, Kim S, Chen M, Bachier C, Shaughnessy P, Hill J, Ljungman P, Battiwalla M, Chhabra S, Daly A, Storek J, Ustun C, Diaz MA, Cerny J, Beitinjaneh A, Yared J, Brown V, Page K, Dahi PB, Ganguly S, Seo S, Chao N, Freytes CO, Saad A, Savani BN, Woo Ahn K, Boeckh M, Heslop HE, Lazarus HM, Auletta JJ, Kamble RT

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
Soyoung Kim PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Kristin Page MD, MHS, MEd Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Child
Child, Preschool
Epstein-Barr Virus Infections
Female
Hematopoietic Stem Cell Transplantation
Herpesvirus 4, Human
Humans
Incidence
Infant
Lymphoproliferative Disorders
Male
Middle Aged
Retrospective Studies
Transplantation Conditioning
Transplantation, Homologous
Viral Load
Young Adult