Preemptive Therapy Based on the Load and Time of EBV-Emia for Preventing EBV Related PTLD after Haploidentical Hematopoietic Stem Cell Transplantation: A Prospective Multicenter Study
| Autor: | Ting Yang, Can Liu, Qifa Liu, Shen Zhang, Xiao-Jun Huang, Na Xu, Zhiping Fan, Yajing Xu, Jieyu Ye, Yu Wang, Jing Sun, Ren Lin, Fen Huang, Li Xuan |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Acute leukemia business.industry medicine.medical_treatment Incidence (epidemiology) Immunology Diseases onset Cell Biology Hematology Hematopoietic stem cell transplantation Biochemistry Gastroenterology Multicenter study hemic and lymphatic diseases Internal medicine medicine Adoptive cellular therapy Rituximab business Viral load medicine.drug |
| Zdroj: | Blood. 134:5693-5693 |
| ISSN: | 1528-0020 0006-4971 |
| Popis: | Backgroud: To evaluate the efficacy of preemptive therapy for preventing EBV related PTLD based on the duration of EBV-emia and the viral loads in the patients undergoing haplo-HSCT, a prospective multicenter study was conducted. Methods: Rituximab or rituximab followed by adoptive cellular therapy was applied for preemptive therapy if EBV-DNA in blood was positive twice consecutively with a rising trend over one log in virus loads or positive consecutively six times without a dropping trend over one log at least within three weeks or not turning negative consecutively eight times within four weeks. Results : Of the 408 patients with acute leukemia enrolled in this study, 133 occurred EBV-emia, including 19 PTLD and 6 end-organ diseases. The patients with EBV-emia had inferior three-year overall survival (OS) and higher non-relapse mortality (NRM) to those without EBV-emia (OS: 58.0%±5.0% vs. 71.0%±3.0%, =0.042; NRM: 27.9%±3.9% vs. 18.9%±2.4%, =0.050, respectively). Compared with non-preemptive group, the negative conversion of EBV-emia was significantly higher (100% vs. 76.1%, =0.002) and the three-year incidence of PTLD was markedly lower in preemptive group (1.3% vs. 21.7%, =0.000). The median time from EBV-emia to EBV diseases onset was 15 days and the durative time of EBV-emia was positively correlated with PTLD occurrence (=0.419, =0.024). Conclusion s: Rituximab preemptive therapy could reduce the incidence of PTLD. Earlier preemptive therapy should be advocated once the EBV-emia is positive persistently regardless of EBV-DNA levels (NCT01883180). Disclosures No relevant conflicts of interest to declare. |
| Databáze: | OpenAIRE |
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