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Original Articles

High incidence but low mortality of EBV-reactivation and PTLD after alloHCT using ATG and PTCy for GVHD prophylaxis

Maria Queralt Salasa Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada;c Hematology Department, Institut Català d'Oncologia - Hospitalet, IDIBELL, Barcelona, Spain

https://orcid.org/0000-0003-4567-3682

Shruti Prema Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Mats Rembergerd Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden

Wilson Lama Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Dennis Dong Hwan Kima Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Fotios Vasilios Michelisa Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Zeyad Al-Shaibania Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Armin Gerbitza Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Jeffrey Howard Liptona Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Auro Viswabandyaa Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Rajat Kumara Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Deepali Kumare Transplant Infectious Diseases and Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada

Jonas Mattssona Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

Arjun Datt Lawa Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada;b Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, ON, CanadaCorrespondence[email protected]

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Abstract

We explore risk factors and impacts of post-transplant EBV-Reactivation (EBV-R) and PTLD in 270 patients that underwent RIC alloHCT using ATG-PTCy and cyclosporine for GVHD prophylaxis. Twenty-five (12%) patients had probable (n = 7) or proven (n = 18) PTLD. Patients were managed with reduction of immunosuppression and 22 with weekly rituximab (375 mg/m² IV). ORR was 84%; 8 (32%) recipients died, and one-year OS and NRM of patients with PTLD was 59.7% and 37%, respectively. One hundred seventy-two (63.7%) recipients had EBV-R. One-year OS and RFS of patients with EBV-R were 68.2% and 60.6%, and of EBV-Negative patients were 62.1% and 50.1%, respectively. High incidence but low mortality of EBV-R and PTLD was documented. EBV-R induced a protective effect on RFS in multivariable analysis (HR 0.91, p = .011). Therefore, EBV-R may have a protective effect on RFS in this setting. Further research is necessary to evaluate the interplay of EBV-R, immune reconstitution, and post-transplant outcomes.

Keywords:

Acknowledgments

The authors thank our patients and the nursing and support staff in the Hans Messner Allogeneic Blood and Marrow Transplant Program.

Author contributions

QS and AL designed the study, interpreted the data and wrote the manuscript. QS and SP collected the data. QS, MR did the statistical analysis. QS developed the research entirely during her stage at Princess Margaret Cancer Center. QS, SP, MR, WL, DHK, FM, ST, JL, AG, RK, JM, AV, JM, DK and AL provided valuable input into the study design and interpretation and reviewed the manuscript.

Disclosure statement

DK has received consulting fees from Atara Bio. The remaining authors declare no relevant conflicts of interest, financial or otherwise.

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High incidence but low mortality of EBV-reactivation and PTLD after alloHCT using ATG and PTCy for GVHD prophylaxis

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High incidence but low mortality of EBV-reactivation and PTLD after alloHCT using ATG and PTCy for GVHD prophylaxis

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