EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases.

Abstract

We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.

• Authors: J Sanz, M Arango, L Senent, I Jarque, P Montesinos, A Sempere, I Lorenzo, G Martín, F Moscardó, E Mayordomo, M Salavert, C Cañigral, B Boluda, C Salazar, J L López-Hontangas, M A Sanz, G F Sanz
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 49 Issue 3 Pg. 397-402 (Mar 2014) ISSN: 1476-5365 [Electronic] England
• PMID: 24292521 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Central Nervous System (pathology)
• Cord Blood Stem Cell Transplantation (adverse effects)
• Epstein-Barr Virus Infections (complications)
• Female
• Graft vs Host Disease
• Hematologic Diseases (physiopathology, therapy)
• Herpesvirus 4, Human
• Humans
• Incidence
• Liver (pathology)
• Lymphoproliferative Disorders (etiology, virology)
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Spleen (pathology)
• Time Factors
• Transplantation Conditioning
• Young Adult