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EBV-associated post-transplant lymphoproliferative disease in patients who received anti-CD 20 after hematopoietic stem cell transplantation.

S. Pagliuca,C. Bommier,D. Michonneau,V. Meignin,M. Salmona,M. Robin,P. Prata,A. Xhaard,F. D. de Fontbrune,L. Feghoul,N. Dhédin,R. D. de Latour,S. Caillat-Zucman,J. L. Goff,G. Socié

Published 2019 in Biology of Blood and Marrow Transplantation

ABSTRACT

Post-transplant lymphoproliferative disease (PTLD) represents a severe complication associated with Epstein Barr Virus (EBV) infection after hematopoietic stem cell transplantation (HSCT). Although anti-CD-20 therapy is now used as a pre-emptive strategy for EBV reactivation, PTLD is still developed by some patients. Here we analyzed outcomes and risk factors associated with PTLD transformation in 208 transplanted patients, diagnosed with EBV DNAemia and receiving at last one course of rituximab. The median age was 42.52 (8.35-74.77) years and median follow-up was 47.33 (3.18-126.20) months. Two-year overall survival (OS) of the entire cohort was 62.8 (95%CI 56.4-69.9) whereas 2-year cumulative incidence function (CIF) of PTLD was 6.3 % (95%CI 3.5-10.1%), for a median follow up of patients diagnosed with PTLD of 37.85 months. Multivariable analysis identified four risk factors associated with PTLD: HSCT from an unrelated donor, recipient human leukocyte antigen (HLA) DRB1*11:01, fever at diagnosis of EBV infection and sex-mismatched HSCT. Presence of more than two risk factors was associated with a higher risk of developing PTLD. This retrospective study identifies risk factors associated with PTLD in EBV infected patients after HSCT and defines patient subgroups that may benefit from intensified pre-emptive strategies.

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