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Survival outcomes of allogeneic hematopoietic cell transplants with EBV‐positive or EBV‐negative post‐transplant lymphoproliferative disorder, A CIBMTR study
Author(s) -
Naik Seema,
Riches Marcie,
Hari Parameswaran,
Kim Soyoung,
Chen Min,
Bachier Carlos,
Shaughnessy Paul,
Hill Joshua,
Ljungman Per,
Battiwalla Minoo,
Chhabra Saurabh,
Daly Andrew,
Storek Jan,
Ustun Celalettin,
Diaz Miguel Angel,
Cerny Jan,
Beitinjaneh Amer,
Yared Jean,
Brown Valerie,
Page Kristin,
Dahi Parastoo B.,
Ganguly Siddhartha,
Seo Sachiko,
Chao Nelson,
Freytes Cesar O.,
Saad Ayman,
Savani Bipin N.,
Woo Ahn Kwang,
Boeckh Michael,
Heslop Helen E.,
Lazarus Hillard M.,
Auletta Jeffery J.,
Kamble Rammurti T.
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13145
Subject(s) - medicine , post transplant lymphoproliferative disorder , hematopoietic cell , lymphoproliferative disorders , immunology , hematopoietic stem cell transplantation , young adult , epstein–barr virus , transplantation , lymphoma , haematopoiesis , stem cell , virus , biology , genetics
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.