Impact of Epstein Barr virus-related complications after high-risk allo-SCT in the era of pre-emptive rituximab

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 4; pp. 579 - 584
• Main Authors: García-Cadenas, I, Castillo, N, Martino, R, Barba, P, Esquirol, A, Novelli, S, Orti, G, Garrido, A, Saavedra, S, Moreno, C, Granell, M, Briones, J, Brunet, S, Navarro, F, Ruiz, I, Rabella, N, Valcárcel, D, Sierra, J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2015; Nature Publishing Group
• Subjects: 13; 14; 38; 692/499; Adolescent; Adult; Aged; Allografts; Bone marrow; Cell Biology; Complications; Complications and side effects; Confidence intervals; Cytomegalovirus; Dosage and administration; Epstein-Barr virus; Epstein-Barr virus diseases; Epstein-Barr Virus Infections - epidemiology; Epstein-Barr Virus Infections - etiology; Epstein-Barr Virus Infections - prevention & control; Female; Graft-versus-host reaction; Hematologic Neoplasms - epidemiology; Hematologic Neoplasms - therapy; Hematology; Herpesvirus 4, Human - physiology; Humans; Immunologic Factors - administration & dosage; Internal Medicine; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; original-article; Patient outcomes; Posttransplant lymphoproliferative disorders; Public Health; Risk analysis; Risk factors; Rituximab; Rituximab - administration & dosage; Stem Cell Transplantation; Stem Cells; Viremia; Virus Activation - drug effects
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2014.298

We monitored 133 high-risk allo-SCT recipients for 6 months after transplant for EBV reactivation by quantitative real-time PCR. Rituximab was given as pre-emptive therapy for viremia >1000 copies/mL. The 1-year cumulative incidence of EBV reactivation was 29.4% (95% confidence interval (CI): 18–40) in patients monitored due to initial high-risk characteristics ( n =93) and 31.8% (95% CI: 19.7–44) in those followed because of the development of refractory GVHD ( n =40). Overall response rate to Rituximab was 83%. Nine patients (9.6%) developed post-transplant lymphoproliferative disorder (PTLD) at a median of +62 days after SCT. Eight of them showed a concomitant CMV reactivation. Second SCT was the only risk factor associated with EBV infection and PTLD in multivariate analysis (hazard ratio (HR) 2.6 (95% CI: 1.1–6.4; P =0.04) and HR 6.4 (95%CI: 1.3–32; P =0.02)). The development of EBV reactivation was not associated with non-relapse mortality or OS ( P =0.97 and P =0.84, respectively).