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    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.

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    Authors
    Fox, C
    Burns, D
    Parker, A
    Peggs, K
    Harvey, C
    Natarajan, S
    Marks, D
    Jackson, B
    Chakupurakal, G
    Dennis, Michael
    Lim, Z
    Cook, G
    Carpenter, B
    Pettitt, A
    Mathew, S
    Connelly-Smith, L
    Yin, J
    Viskaduraki, M
    Chakraverty, R
    Orchard, K
    Shaw, B
    Byrne, J
    Brookes, C
    Craddock, C
    Chaganti, S
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    Affiliation
    Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
    Issue Date
    2014-02
    
    Metadata
    Show full item record
    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.
    Citation
    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. 2014, 49 (2):280-6 Bone Marrow Transplant.
    Journal
    Bone Marrow Transplantation
    URI
    http://hdl.handle.net/10541/315910
    DOI
    10.1038/bmt.2013.170
    PubMed ID
    24212561
    Type
    Article
    Language
    en
    ISSN
    1476-5365
    ae974a485f413a2113503eed53cd6c53
    10.1038/bmt.2013.170
    Scopus Count
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    All Christie Publications

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