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Risk factors for post‐transplant lymphoproliferative disorder after Thymoglobulin‐conditioned hematopoietic cell transplantation
Author(s) -
Kalra Amit,
Roessner Cameron,
Jupp Jennifer,
Williamson Tyler,
Tellier Raymond,
Chaudhry Ahsan,
Khan Faisal,
Taparia Minakshi,
JimenezZepeda Victor H.,
Stewart Douglas A.,
Daly Andrew,
Storek Jan
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13150
Subject(s) - medicine , serostatus , post transplant lymphoproliferative disorder , thymoglobulin , incidence (geometry) , transplantation , risk factor , hematopoietic stem cell transplantation , gastroenterology , immunology , lymphoma , viral load , rituximab , virus , kidney transplantation , physics , optics
Epstein‐Barr virus ( EBV )‐induced post‐transplant lymphoproliferative disorder ( PTLD ) occurs frequently when rabbit antithymocyte globulin ( ATG ) is used in hematopoietic cell transplant ( HCT ) conditioning. We retrospectively studied 554 patients undergoing ATG ‐conditioned myeloablative HCT . Strategies used to minimize mortality due to PTLD were either therapy of biopsy‐diagnosed PTLD in the absence of EBV DNA emia monitoring (n = 266) or prompt therapy of presumed PTLD (based on clinical/radiologic signs and high EBV DNA emia, in the setting of weekly EBV DNA emia monitoring) (n = 199). Both strategies resulted in similar mortality due to PTLD (0.7% vs 1% at 2 years, P = .43) and similar overall survival (63% vs 67% at 2 years, P = .23) even though there was a trend toward higher PTLD incidence with the prompt therapy. Donor positive with recipient negative EBV (D+R−) serostatus was a risk factor for developing PTLD . Older patient age, HLA ‐mismatched donor, and graft‐versus‐host disease were not associated with increased risk of PTLD . In summary, in ATG ‐conditioned HCT , D+R− serostatus, but not older age, mismatched donor or GVHD is a risk factor for developing PTLD . EBV DNA emia monitoring may be a weak risk factor for developing/diagnosing PTLD ; the monitoring coupled with prompt therapy does not improve survival.