Posttransplant lymphoproliferative disorder in children after allogeneic hematopoietic stem cell transplantation: a single-center experience and literature review

Skvortsova, Yulia; Balashov, D; Shelikhova, Larisa; Скоробогатова, Е. В.; Krivolapov, Yurij A.; Shipitsina, Irina; Gutovskaya, Elena; Bajdildina, Dina D.; Калинина, И. И.; Петрова, У. Н.; Abrosimov, Andrej B.; Kozlovskaya, Svetlana; Maschan, Michael; Konovalov, Dmitrij M.; Abramov, D. S.; Tereshchenko, G. V.; Rumyantsev, A.G.; Самочатова, Е. В.; Novichkova, Galina; Maschan, Alexej A.

doi:10.18620/ctt-1866-8836-2017-6-2-8-25

Cited by 1 publication

(7 citation statements)

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“…It is also important to note that therapies other than rituximab have been used to prevent PTLD, including ganciclovir, donor lymphocyte infusion (DLI), or EBV‐specific cytotoxic T lymphocytes (CTLs). However, data on the clinical efficacy of ganciclovir in the prevention of PTLD are not consistent 90 . In addition, ganciclovir use can cause significant myelosuppression 90 …”

Section: Discussionmentioning

confidence: 99%

“…The management of EBV infection remains problematic and leads to high morbidity in transplant recipients. Rituximab is the most recommended and effective therapy to prevent PTLD in stem cell transplant recipients 8,9,90 . However, its use could have harmful consequences for patients who are already immunosuppressed by promoting the occurrence of other fatal infections.…”

Section: Discussionmentioning

confidence: 99%

“…90 Despite its low toxicity and relative effectiveness, the use of CTLs is limited because the generation of EBV-specific cytotoxic lymphocytes requires time and expense. 90 A better understanding of the determinants of adverse EBV outcomes is essential to develop effective preventive approaches. Our study showed that sex has a possible role in explaining more severe forms of EBV infection in pediatric HSCT recipients, with girls being at higher risk of increased EBV-VL and rituximab treatment, although they were not more likely to have EBV DNAemia compared to boys.…”

Section: F I G U R Ementioning

confidence: 99%

“…However, data on the clinical efficacy of ganciclovir in the prevention of PTLD are not consistent. 90 In addition, ganciclovir use can cause significant myelosuppression. 90 The use of DLI is limited due to the risk of inducing or aggravating GvHD.…”

Section: F I G U R Ementioning

confidence: 99%

“…Therefore, risk factors for rituximab use in our study should be interpreted accordingly.In conclusion, an understanding of the EBV risk factors in HSCTrecipients is important for reducing EBV-associated morbidity.The management of EBV infection remains problematic and leads to high morbidity in transplant recipients. Rituximab is the recommended and effective therapy to prevent PTLD in stem cell transplant recipients 8,9,90. However, its use could have harmful consequences for patients who are already immunosuppressed by promoting the occurrence of other fatal infections.…”

mentioning

confidence: 99%

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Risk factors for post‐transplant Epstein‐Barr virus events in pediatric recipients of hematopoietic stem cell transplants

Bonong

Buteau

Duval

et al. 2021

Pediatric Transplantation

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Background Epstein‐Barr virus (EBV) can cause severe disease following hematopoietic stem cell transplant (HSCT), including post‐transplant lymphoproliferative disorder (PTLD). The objective was to analyze risk factors associated with post‐transplant EBV outcomes among pediatric allogeneic HSCT recipients. Methods We used data from 156 pediatric allogeneic HSCT recipients enrolled in the Canadian multicenter TREASuRE study. Cox and Prentice‐Williams‐Petersen models were used to analyze risk factors for post‐transplant EBV events including occurrence and recurrence of EBV DNAemia, increase in EBV viral load (EBV‐VL), and preemptive use of rituximab, an effective therapy against PTLD. Results Females were at higher risk for increasing EBV‐VL (adjusted hazard ratio (HR) = 2.83 [95% confidence intervals (CI): 1.33–6.03]) and rituximab use (HR = 3.08 [1.14–8.30]), but had the same EBV DNAemia occurrence (HR = 1.21 [0.74–1.99]) and recurrence risks (HR=1.05 [0.70–1.58]) compared to males. EBV DNAemia was associated with recipient pre‐transplant EBV seropositivity (HR = 2.47 [1.17–5.21]) and with graft from an EBV‐positive donor (HR = 3.53 [1.95–6.38]). Anti‐thymocyte globulin (ATG) was strongly associated with all EBV outcomes, including the use of rituximab (HR = 5.33 [1.47–19.40]). Mycophenolate mofetil (MMF) significantly decreased the risk of all EBV events including the rituximab use (HR = 0.13 [0.03–0.63]). Conclusion This study in pediatric allogeneic HSCT patients reveals a reduced risk of all EBV outcomes with the use of MMF. Risk factors for EBV events such as EBV‐VL occurrence and recurrence include EBV positivity in the donor and recipient, and use of ATG, whereas risk factors for the most severe forms of EBV outcome (EBV‐VL and the use of rituximab) include female sex and ATG use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%