Background. The objective of this analysis was to investigate prognostic factors that influence the outcome of Epstein-Barr virus (EBV)-related posttransplant lymphoproliferative disorder (PTLD) after a rituximab-based treatment in the allogeneic hematopoietic stem cell transplant (HSCT) setting.Methods. A total of 4466 allogeneic HSCTs performed between 1999 and 2011 in 19 European Group for Blood and Marrow Transplantation centers were retrospectively analyzed for PTLD, either biopsy-proven or probable disease.Results. One hundred forty-four cases of PTLD were identified, indicating an overall EBV-related PTLD frequency of 3.22%, ranging from 1.16% for matched-family donor, 2.86% for mismatched family donor, 3.97% in matched unrelated donors, and 11.24% in mismatched unrelated donor recipients. In total, 69.4% patients survived PTLD. Multivariable analysis showed that a poor response of PTLD to rituximab was associated with an age ≥30 years, involvement of extralymphoid tissue, acute GVHD, and a lack of reduction of immunosuppression upon PTLD diagnosis. In the prognostic model, the PTLD mortality increased with the increasing number of factors: 0-1, 2, or 3 factors being associated with mortality of 7%, 37%, and 72%, respectively (P <. 0001). Immunosuppression tapering was associated with a lower PTLD mortality (16% vs 39%), and a decrease of EBV DNAemia in peripheral blood during therapy was predictive of better survival.Conclusions. More than two-thirds of patients with EBV-related PTLD survived after rituximab-based treatment. Reduction of immunosuppression was associated with improved outcome, whereas older age, extranodal disease, and acute graft-vs-host disease predicted poor outcome. © 2013 The Author.

Styczynski, J., Gil, L., Tridello, G., Ljungman, P., Donnelly, J., Van Der Velden, W., et al. (2013). Response to rituximab-based therapy and risk factor analysis in epstein barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: A study from the infectious diseases working party of the european group for blood and marrow transplantation. CLINICAL INFECTIOUS DISEASES, 57(6), 794-802 [10.1093/cid/cit391].

Response to rituximab-based therapy and risk factor analysis in epstein barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: A study from the infectious diseases working party of the european group for blood and marrow transplantation

Migliavacca, Maddalena;Balduzzi, Adriana;
2013

Abstract

Background. The objective of this analysis was to investigate prognostic factors that influence the outcome of Epstein-Barr virus (EBV)-related posttransplant lymphoproliferative disorder (PTLD) after a rituximab-based treatment in the allogeneic hematopoietic stem cell transplant (HSCT) setting.Methods. A total of 4466 allogeneic HSCTs performed between 1999 and 2011 in 19 European Group for Blood and Marrow Transplantation centers were retrospectively analyzed for PTLD, either biopsy-proven or probable disease.Results. One hundred forty-four cases of PTLD were identified, indicating an overall EBV-related PTLD frequency of 3.22%, ranging from 1.16% for matched-family donor, 2.86% for mismatched family donor, 3.97% in matched unrelated donors, and 11.24% in mismatched unrelated donor recipients. In total, 69.4% patients survived PTLD. Multivariable analysis showed that a poor response of PTLD to rituximab was associated with an age ≥30 years, involvement of extralymphoid tissue, acute GVHD, and a lack of reduction of immunosuppression upon PTLD diagnosis. In the prognostic model, the PTLD mortality increased with the increasing number of factors: 0-1, 2, or 3 factors being associated with mortality of 7%, 37%, and 72%, respectively (P <. 0001). Immunosuppression tapering was associated with a lower PTLD mortality (16% vs 39%), and a decrease of EBV DNAemia in peripheral blood during therapy was predictive of better survival.Conclusions. More than two-thirds of patients with EBV-related PTLD survived after rituximab-based treatment. Reduction of immunosuppression was associated with improved outcome, whereas older age, extranodal disease, and acute graft-vs-host disease predicted poor outcome. © 2013 The Author.
Articolo in rivista - Articolo scientifico
Epstein-Barr virus; hematopoietic stem cell transplantation; post-transplant lymphoproliferative disorder; prognostic model; risk factors; Adolescent; Adult; Aged; Antibodies, Monoclonal, Murine-Derived; Child; Child, Preschool; DNA, Viral; Epstein-Barr Virus Infections; Europe; Herpesvirus 4, Human; Humans; Immunologic Factors; Infant; Kaplan-Meier Estimate; Lymphoproliferative Disorders; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Rituximab; Viral Load; Hematopoietic Stem Cell Transplantation; Microbiology (medical); Infectious Diseases
English
2013
57
6
794
802
none
Styczynski, J., Gil, L., Tridello, G., Ljungman, P., Donnelly, J., Van Der Velden, W., et al. (2013). Response to rituximab-based therapy and risk factor analysis in epstein barr virus-related lymphoproliferative disorder after hematopoietic stem cell transplant in children and adults: A study from the infectious diseases working party of the european group for blood and marrow transplantation. CLINICAL INFECTIOUS DISEASES, 57(6), 794-802 [10.1093/cid/cit391].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/221941
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