Survival outcomes of allogeneic hematopoietic cell transplants with EBV-positive or EBV-negative post-transplant lymphoproliferative disorder, A CIBMTR study Journal Article
| Authors: | 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, M. A.; Cerny, J.; Beitinjaneh, A.; Yared, J.; Brown, V.; Page, K.; Dahi, P. B.; Ganguly, S.; Seo, S.; Chao, N.; Freytes, C. O.; Saad, A.; Savani, B. N.; Woo Ahn, K.; Boeckh, M.; Heslop, H. E.; Lazarus, H. M.; Auletta, J. J.; Kamble, R. T. |
| Article Title: | Survival outcomes of allogeneic hematopoietic cell transplants with EBV-positive or EBV-negative post-transplant lymphoproliferative disorder, A CIBMTR study |
| 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 (EBVpos), EBV-negative (EBVneg) 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 (EBVpos= 222, 83%; EBVneg= 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 EBVpos or EBVnegPTLD cases except that absolute lymphocyte count recovery was slower, and CMV reactivation was later in EBVneg PTLD [EBVpos 32 (5-95) days versus EBVneg 47 (10-70) days, P =.016]. There was no impact on survival by EBV status in multivariable analysis [EBVneg RR 1.42, 95% CI 0.94-2.15, P =.097]. Conclusions: There is no difference in survival outcomes for patients with EBVpos or EBVneg PTLD occurring following alloHCT and 1-year survival is poor. Features of conditioning and use of serotherapy remain important. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd |
| Keywords: | adolescent; adult; child; aged; survival analysis; graft infection; major clinical study; overall survival; clinical feature; histopathology; methotrexate; follow up; incidence; cohort analysis; cyclophosphamide; in vivo study; cord blood stem cell transplantation; myeloablative conditioning; nonmyeloablative conditioning; whole body radiation; graft versus host reaction; reduced intensity conditioning; allogeneic hematopoietic stem cell transplantation; graft survival; t cell depletion; tacrolimus; convalescence; cyclosporine; cytomegalovirus; epstein barr virus; alemtuzumab; lymphocyte count; thymocyte antibody; virus reactivation; posttransplant lymphoproliferative disease; clinical outcome; epstein barr virus infection; epstein-barr virus; mycophenolate mofetil; prognosis; human; male; female; priority journal; article; allogeneic hematopoietic cell transplant; matched related donor; post-transplant lymphoproliferative disorder |
| Journal Title: | Transplant Infectious Disease |
| Volume: | 21 |
| Issue: | 5 |
| ISSN: | 1398-2273 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2019-10-01 |
| Start Page: | e13145 |
| Language: | English |
| DOI: | 10.1111/tid.13145 |
| PUBMED: | 31301099 |
| PROVIDER: | scopus |
| PMCID: | PMC7239317 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 November 2019 -- Source: Scopus |
