Outcome of treatment of Epstein-Barr virus-related post-transplant lymphoproliferative disorder in hematopoietic stem cell recipients: a comprehensive review of reported cases.
Post-transplant lymphoproliferative disorder (PTLD) caused by Epstein-Barr virus (EBV) is an important complication in high-risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. Before the current methods of anti-EBV therapy were introduced, the mortality from PTLD after HSCT was >80%. With current approaches the mortality from EBV-PTLD can be significantly reduced. The published literature and meeting abstracts were reviewed to assess the impact of different management strategies against EBV-PTLD. This analysis of reported outcomes indicates that preemptive use of rituximab and EBV-cytotoxic T lymphocytes (CTL) significantly reduced the risk of death due to EBV-PTLD in HSCT recipients with survival rates of 89.7% and 94.1%, respectively. Therapy of established PTLD also reduced the risk of fatal outcome. However, the overall success rates were lower than after preemptive therapy, reaching 63% and 88.2% of total EBV-DNA clearance with rituximab and CTL therapy, respectively. A reduction of immunosuppression and/or donor lymphocyte infusion might also reduce the risk of death due to EBV-PTLD. Although it is difficult to estimate these effects more precisely because of the frequent use of combination therapies, the responses to these modalities can be estimated to be 56.6% and 41.0%, respectively. Finally, chemotherapy seems not to contribute to improved survival of patients with PTLD after HSCT and antiviral agents are not active against PTLD.
Styczynski
J
J
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. jstyczynski@cm.umk.pl
Einsele
H
H
Gil
L
L
Ljungman
P
P
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D020031:Epstein-Barr Virus Infections / Q000401:mortality / Q000517:prevention & control / Q000628:therapy* / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008232:Lymphoproliferative Disorders / Q000401:mortality / Q000517:prevention & control / Q000628:therapy / Q000821:virology; D000069283:Rituximab; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab