Format

Send to

Choose Destination
Bone Marrow Transplant. 2014 Feb;49(2):280-6. doi: 10.1038/bmt.2013.170. Epub 2013 Nov 11.

EBV-associated post-transplant lymphoproliferative disorder following in vivo T-cell-depleted allogeneic transplantation: clinical features, viral load correlates and prognostic factors in the rituximab era.

Author information

1
1] Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK [2] School of Cancer Sciences, University of Birmingham, Birmingham, UK.
2
1] School of Cancer Sciences, University of Birmingham, Birmingham, UK [2] University Hospitals Birmingham NHS Trust, Birmingham, UK.
3
The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
4
University College London, Cancer Institute, London, UK.
5
Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
6
Manchester Royal Infirmary, Manchester, UK.
7
University Hospitals Bristol NHS Trust, Bristol, UK.
8
The Royal Marsden, London, UK.
9
University Hospitals Birmingham NHS Trust, Birmingham, UK.
10
The Christie NHS Foundation Trust, Manchester, UK.
11
King's College Hospital NHS Trust, London, UK.
12
St James's Institute of Oncology, Leeds, UK.
13
Royal Free London NHS Trust, London, UK.
14
University of Liverpool, Liverpool, UK.
15
The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
16
University Hospitals of Leicester NHS Trust, Leicester, UK.
17
Cancer Research UK Clinical Trials Unit, University of Birmingham, UK.
18
University Hospital Southampton NHS Trust, Southampton, UK.

Abstract

EBV-associated post-transplant lymphoproliferative disease (PTLD) following Alemtuzumab-based allo-SCT is a relatively uncommon and challenging clinical problem but has not received detailed study in a large cohort. Quantitative-PCR (qPCR) monitoring for EBV reactivation post allo-SCT is now commonplace but its diagnostic and predictive value remains unclear. Sixty-nine patients with PTLD following Alemtuzumab-based allo-SCT were studied. Marked clinicopathological heterogeneity was evident; lymphadenopathy was frequently absent, whereas advanced extranodal disease was common. The median viral load at clinical presentation was 49 300 copies/mL (50-65 200 000 copies/mL) and, notably, 23% and 45% of cases, respectively, had 10 000 and 40 000 copies/mL. The overall response rate to rituximab as first-line therapy was 70%. For rituximab failures, chemotherapy was ineffectual but DLIs were successful. A four-parameter prognostic index predicted response to therapy (OR 0.30 (0.12-0.74); P=0.009] and PTLD mortality (hazard ratio (HR) 1.81 (1.12-2.93) P=0.02) on multivariate analysis. This is the largest detailed series of EBV-associated PTLD after allo-SCT. At clinical presentation, EBV-qPCR values are frequently below customary thresholds for pre-emptive therapy, challenging current paradigms for monitoring and intervention. A four-point score identifies a proportion of patients at risk of rituximab-refractory disease for whom alternative therapy is needed.

PMID:
24212561
DOI:
10.1038/bmt.2013.170
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Nature Publishing Group
Loading ...
Support Center