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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-02

AUTHORS

C P Fox, D Burns, A N Parker, K S Peggs, C M Harvey, S Natarajan, D I Marks, B Jackson, G Chakupurakal, M Dennis, Z Lim, G Cook, B Carpenter, A R Pettitt, S Mathew, L Connelly-Smith, J A L Yin, M Viskaduraki, R Chakraverty, K Orchard, B E Shaw, J L Byrne, C Brookes, C F Craddock, S Chaganti

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. More... »

PAGES

280

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/bmt.2013.170

DOI

http://dx.doi.org/10.1038/bmt.2013.170

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1042845189

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24212561


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