EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases

Autores de IIS La Fe

• Jaime Sanz Caballer

  Autor

• María Leonor Senent Peris

  Autor

• Isidro Jarque Ramos

  Autor

• Pau Montesinos Fernández

  Autor

• Amparo Sempere Talens

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• Guillermo Martin Aragones

  Autor

• Federico Moscardo Garcia

  Autor

• Empar Mayordomo Aranda

  Autor

• Miguel Salavert Lletí

  Autor

• Carolina Cañigral Ortiz

  Autor

• Blanca Boluda Pascual

  Autor

• Carme Salazar Guiral

  Autor

• José Luis López Hontangas

  Autor

• Miguel Ángel Sanz Alonso

  Autor

• Guillermo Sanz Santillana

  Autor

Participantes ajenos a IIS La Fe

• Arango M

Grupos

• Hematología y Hemoterapia

• Infección Grave

Abstract

We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P < 0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.

Keywords

• EBV-PTLD; UCBT; hematological malignancies