Long-term outcome of Epstein-Barr virus DNAemia and PTLD with the use of preemptive rituximab following allogeneic HSCT

We studied retrospectively the outcome of Epstein-Barr virus (EBV)-related disease with EBV monitoring and preemptive rituximab to prevent post-transplant lymphoproliferative disorder (PTLD) in 319 consecutive allogeneic stem cell transplantations 2004-2012. Patients who received anti-thymocyte globulin (ATG) or alemtuzumab were regarded as high-risk for PTLD (n = 214). EBV DNAemia ≥1000 copies/mL plasma was observed in 50 (23%) of the high-risk patients. Thirty-three of the high-risk (15%) and one of the low-risk (1%) patients received rituximab, in combination with reduction of immunosuppression (n = 24) or chemotherapy (n = 4). Although rituximab was initiated only 5 d after first EBV load ≥1000 copies/mL, 85% of the rituximab-treated patients developed symptoms (lymphadenopathy 50%, fever 76%, and encephalitis/meningitis 12%). Response-rate to EBV treatment was 88%. Overall survival at 1- and 5-year was 71 and 52% for rituximab-treated patients, which was not inferior to all other patients post-transplant. In conclusion, rituximab therapy for EBV DNAemia does not affect long-term survival negatively.

Hallböök, HeleneUppsala universitet,Hematologi(Swepub:uu)helehall (författare)
Arvidson, Johan,1953-Uppsala universitet,Barnneurologi/Barnonkologi(Swepub:uu)johanas (författare)
Sällström, KalleUppsala universitet,Infektionssjukdomar (författare)
Bondeson, KåreUppsala universitet,Klinisk virologi(Swepub:uu)karebond (författare)
Pauksen, KarlisUppsala universitet,Infektionssjukdomar(Swepub:uu)karlpauk (författare)
Uppsala universitetInfektionssjukdomar (creator_code:org_t)

Ingår i:Leukemia and Lymphoma: Informa UK Limited59:5, s. 1172-11791042-81941029-2403

Av författaren/redakt...: Kinch, Amelie, 1 ...; Hallböök, Helene; Arvidson, Johan, ...; Sällström, Kalle; Bondeson, Kåre; Pauksen, Karlis

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