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.
Authors
Fox, CBurns, 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
Affiliation
Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UKIssue Date
2014-02
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Show full item recordAbstract
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 TransplantationDOI
10.1038/bmt.2013.170PubMed ID
24212561Type
ArticleLanguage
enISSN
1476-5365ae974a485f413a2113503eed53cd6c53
10.1038/bmt.2013.170
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