High incidence but low mortality of EBV-reactivation and PTLD after alloHCT using ATG and PTCy for GVHD prophylaxis

We explore risk factors and impacts of post-transplant EBV-Reactivation (EBV-R) and PTLD in 270 patients that underwent RIC alloHCT using ATG-PTCy and cyclosporine for GVHD prophylaxis. Twenty-five (12%) patients had probable (n = 7) or proven (n = 18) PTLD. Patients were managed with reduction of i...

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Bibliographic Details
Published in:Leukemia & lymphoma 2020, Vol.61 (13), p.3198-3208
Main Authors: Salas, Maria Queralt, Prem, Shruti, Remberger, Mats, Lam, Wilson, Kim, Dennis Dong Hwan, Michelis, Fotios Vasilios, Al-Shaibani, Zeyad, Gerbitz, Armin, Lipton, Jeffrey Howard, Viswabandya, Auro, Kumar, Rajat, Kumar, Deepali, Mattsson, Jonas, Law, Arjun Datt
Format: Article
Language:English
Subjects:
alloHCT
ATG
Clinical Immunology
Epstein-Barr Virus
Epstein-Barr Virus Infections - epidemiology
Epstein-Barr Virus Infections - prevention & control
Graft vs Host Disease - epidemiology
Graft vs Host Disease - etiology
Graft vs Host Disease - prevention & control
Hematopoietic Stem Cell Transplantation - adverse effects
Herpesvirus 4, Human
Humans
Incidence
Klinisk immunologi
Lymphoproliferative Disorders - diagnosis
Lymphoproliferative Disorders - epidemiology
Lymphoproliferative Disorders - etiology
Medicin och hälsovetenskap
PTCy
PTLD
reduced intensity conditioning
Retrospective Studies
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Summary:We explore risk factors and impacts of post-transplant EBV-Reactivation (EBV-R) and PTLD in 270 patients that underwent RIC alloHCT using ATG-PTCy and cyclosporine for GVHD prophylaxis. Twenty-five (12%) patients had probable (n = 7) or proven (n = 18) PTLD. Patients were managed with reduction of immunosuppression and 22 with weekly rituximab (375 mg/m 2 IV). ORR was 84%; 8 (32%) recipients died, and one-year OS and NRM of patients with PTLD was 59.7% and 37%, respectively. One hundred seventy-two (63.7%) recipients had EBV-R. One-year OS and RFS of patients with EBV-R were 68.2% and 60.6%, and of EBV-Negative patients were 62.1% and 50.1%, respectively. High incidence but low mortality of EBV-R and PTLD was documented. EBV-R induced a protective effect on RFS in multivariable analysis (HR 0.91, p = .011). Therefore, EBV-R may have a protective effect on RFS in this setting. Further research is necessary to evaluate the interplay of EBV-R, immune reconstitution, and post-transplant outcomes.
ISSN:1042-8194
1029-2403
1029-2403
DOI:10.1080/10428194.2020.1797010