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Greatly reduced risk of EBV reactivation in rituximab-experienced recipients of alemtuzumab-conditioned allogeneic HSCT.

Burns, D M and Rana, S and Martin, E and Nagra, S and Ward, J and Osman, Husam and Bell, A I and Moss, P and Russell, N H and Craddock, C F and Fox, C P and Chaganti, S (2016) Greatly reduced risk of EBV reactivation in rituximab-experienced recipients of alemtuzumab-conditioned allogeneic HSCT. Bone marrow transplantation, 51 (6). pp. 825-32. ISSN 1476-5365.

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Official URL: http://www.nature.com/bmt/journal/v51/n6/full/bmt2...

Abstract

EBV-associated post-transplant lymphoproliferative disease (PTLD) remains an important complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). We retrospectively analysed the incidence and risk factors for EBV reactivation in 186 adult patients undergoing consecutive allo-HSCT with alemtuzumab T-cell depletion at a single centre. The cumulative incidence of EBV reactivation was 48% (confidence interval (CI) 41-55%) by 1 year, with an incidence of high-level EBV reactivation of 18% (CI 13-24%); 8 patients were concurrently diagnosed with PTLD. Amongst patients with high-level reactivation 31/38 (82%) developed this within only 2 weeks of first EBV qPCR positivity. In univariate analysis age⩾50 years was associated with significantly increased risk of EBV reactivation (hazard ratio (HR) 1.54, CI 1.02-2.31; P=0.039). Furthermore, a diagnosis of non-Hodgkin lymphoma (NHL) was associated with greatly reduced risk of reactivation (HR 0.10, CI 0.03-0.33; P=0.0001) and this was confirmed in multivariate testing. Importantly, rituximab therapy within 6 months prior to allo-HSCT was also highly predictive for lack of EBV reactivation (HR 0.18, CI 0.07-0.48; P=0.001) although confounding with NHL was apparent. Our data emphasise the risk of PTLD associated with alemtuzumab. Furthermore, we report the clinically important observation that rituximab, administered in the peri-transplant period, may provide effective prophylaxis for PTLD.

Item Type: Article
Subjects: WH Haemic and lymphatic systems. Haematology
Divisions: Clinical Support > Pathology
Related URLs:
Depositing User: Preeti Puligari
Date Deposited: 30 Mar 2017 11:13
Last Modified: 30 Mar 2017 11:13
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1308

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