Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab

W. J F M Van Der Velden, Takehiko Mori, W. B C Stevens, A. F J De Haan, F. F. Stelma, N. M A Blijlevens, J. P. Donnelly

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Abstract

The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/disease and EBV-related mortality among 273 consecutive recipients of a T-cell-depleted allo-SCT during two periods: (a) before the implementation of a comprehensive protocol (2006-2008) and (b) afterwards (2009-2011). EBV infection was detected in 61 (22%) cases, and 28 cases were considered to have had EBV disease. Treatment with antithymocyte globulin was the most important risk factor (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.3-4.2, P=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days, P=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12%) vs 11/28 (39%), P=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6%) vs 8/28 (29%), OR 0.2; 95% CI 0.05-0.9, P=0.03). The EBV protocol proved feasible and resulted in faster initiation of pre-emptive therapy, the diagnosis in an earlier stage of EBV disease, and decreased EBV-related mortality.

Original languageEnglish
Pages (from-to)1465-1471
Number of pages7
JournalBone Marrow Transplantation
Volume48
Issue number11
DOIs
Publication statusPublished - 2013 Nov

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Epstein-Barr Virus Infections
Lymphoproliferative Disorders
Human Herpesvirus 4
Transplants
Mortality
Odds Ratio
Confidence Intervals
Antilymphocyte Serum
Rituximab
Therapeutics
T-Lymphocytes
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab. / Van Der Velden, W. J F M; Mori, Takehiko; Stevens, W. B C; De Haan, A. F J; Stelma, F. F.; Blijlevens, N. M A; Donnelly, J. P.

In: Bone Marrow Transplantation, Vol. 48, No. 11, 11.2013, p. 1465-1471.

Research output: Contribution to journalArticle

Van Der Velden, W. J F M ; Mori, Takehiko ; Stevens, W. B C ; De Haan, A. F J ; Stelma, F. F. ; Blijlevens, N. M A ; Donnelly, J. P. / Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab. In: Bone Marrow Transplantation. 2013 ; Vol. 48, No. 11. pp. 1465-1471.
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abstract = "The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/disease and EBV-related mortality among 273 consecutive recipients of a T-cell-depleted allo-SCT during two periods: (a) before the implementation of a comprehensive protocol (2006-2008) and (b) afterwards (2009-2011). EBV infection was detected in 61 (22{\%}) cases, and 28 cases were considered to have had EBV disease. Treatment with antithymocyte globulin was the most important risk factor (odds ratio (OR) 2.4; 95{\%} confidence interval (CI) 1.3-4.2, P=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days, P=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12{\%}) vs 11/28 (39{\%}), P=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6{\%}) vs 8/28 (29{\%}), OR 0.2; 95{\%} CI 0.05-0.9, P=0.03). The EBV protocol proved feasible and resulted in faster initiation of pre-emptive therapy, the diagnosis in an earlier stage of EBV disease, and decreased EBV-related mortality.",
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