title: Marked increased risk of Epstein-Barr virus-related complications with the addition of antithymocyte globulin to a nonmyeloablative conditioning prior to unrelated umbilical cord blood transplantation.
abstract: Umbilical cord blood (UCB) is increasingly used as an alternative source of hematopoietic stem cells for transplantation for patients who lack a suitable sibling donor. Despite concerns about a possible increased risk of Epstein-Barr virus (EBV) posttransplantation lymphoproliferative disorder (PTLD) after UCB transplantation, early reports documented rates of PTLD comparable to those reported after HLA-matched unrelated marrow myeloablative (MA) transplantations. To further investigate the incidence of EBV PTLD after UCB transplantation and potential risk factors, we evaluated the incidence of EBV-related complications in 335 patients undergoing UCB transplantation with an MA or nonmyeloablative (NMA) preparative regimen. The incidence of EBV-related complications was a 4.5% overall, 3.3% for MA transplantations, and 7% for NMA transplantations. However, the incidence of EBV-related complications was significantly higher in a subset of patients treated with an NMA preparative regimen that included antithymocyte globulin (ATG) versus those that did not (21% vs 2%; P < .01). Nine of 11 patients who developed EBV PTLD were treated with rituximab (anti-CD20 antibody), with the 5 responders being alive and disease free at a median of 26 months. Use of ATG in recipients of an NMA preparative regimen warrants close monitoring for evidence of EBV reactivation and potentially preemptive therapy with rituximab.
authors.affiliation: Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA. bruns072@umn.edu
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Todd
authors.initials: T
authors.lastname: DeFor
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.forename: Jakub
authors.initials: J
authors.lastname: Tolar
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: van Burik
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D006801:Humans; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014766:Viremia / Q000209:etiology
chemical_list: D000961:Antilymphocyte Serum