Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/1852
Title: Dynamics of Epstein–Barr virus on post-transplant lymphoproliferative disorders after antithymocyte globulin-conditioned allogeneic hematopoietic cell transplant.
Author: Lindsay, J.
Othman, J.
Yong, M.
Ritchie, D.
Chee, L.
Tay, K.
Tio, S.
Kerridge, I.
Fay, K.
Stevenson, W.
Arthur, C.
Chen, S.
Kong, David C. M.
Greenwood, M.
Pergam, S.
Liu, C.
Slavin, M.
Issue Date: 2021
Publication Title: Transplant Infectious Disease
Volume: 23
Issue: 5
Start Page: e13719
Abstract: Background The use of antithymocyte globulin (ATG) in allogeneic hematopoietic cell transplant (HCT) is associated with an increased risk of Epstein–Barr virus (EBV) reactivation and post-transplant lymphoproliferative disorders (PTLD). The dynamics and outcomes of EBV-DNAemia are not well described in this population. Methods We retrospectively assessed the kinetics of EBV-DNAemia after ATG conditioning of HCT recipients. Receiver operating characteristic (ROC) curves were used to assess EBV-DNAemia to predict EBV-PTLD in this group. Results A total of 174/405 (43%) consecutive HCT recipients from two centers met inclusion criteria of ATG conditioned, non-B-cell lymphoma patients. Of these with EBV-DNA measured using standardized IU/ml, 78.6% (92/117) developed EBV-DNAemia: 62% spontaneously resolved; 19% cleared after preemptive rituximab, and 13% developed EBV-PTLD. ROC curve analysis using maximum pre-EBV-PTLD EBV-DNAemia, demonstrated an AUC of 0.912 with EBV-DNAemia of 9782 IU/ml, associated with 82.6% sensitivity and 94.4% specificity for development of EBV-PTLD. Median time for EBV-DNAemia to increase from initial detection to >1000 IU/ml was 7 days; to >10 000 IU/ml, 12 days; and to >100 000 IU/ml, 18 days. Median EBV-DNAemia level prior to administration of rituximab was significantly lower in patients with successful preemptive treatment, compared with those who developed EBV-PTLD (3.41 log10 IU/ml [3.30–3.67] vs. 4.34 log10 IU/ml [3.85–5.13], p = .002; i.e., 2628 IU/ml vs. 21 965 IU/ml, respectively). Conclusions EBV-DNAemia >10 000 IU/ml was the strongest predictor of the development of EBV-PTLD, and progression to this level was rapid in ATG-conditioned HCT recipients. This information may guide EBV-PTLD management strategies in these high-risk patients.
URI: http://hdl.handle.net/11054/1852
DOI: https://doi.org/10.1111/tid.13719
Internal ID Number: 01857
Health Subject: ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT (HCT)
ANTITHYMOCYTE GLOBULIN (ATG)
EPSTEIN-BARR VIRUS (EBV)
POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS (PTLD)
Type: Journal Article
Article
Appears in Collections:Research Output

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