Molecular monitoring and stepwise preemptive therapy for Epstein–Barr virus viremia after allogeneic stem cell transplantation

Liu, Qifa; Xuan, Li; Liu, Hui; Huang, Fen; Zhou, Hongsheng; Zhang, Fan; Zhao, Ke; Wu, Meiqing; Xu, Lei; Zhai, Xiao; Zhang, Fuhua; Liu, Can; Sun, Jing; Huang, Xiao‐Jun

doi:10.1002/ajh.23452

Cited by 43 publications

(50 citation statements)

References 37 publications

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“…No CMV disease or EBVrelated post transplantation lymphoproliferative disorder developed in this study may also due to preemptively treating for viremia. 44,45 Similar to ISD-HSCT, the NRM in our haplo-cord-HSCT was lowered than others after UCBT or HID-HSCT alone. 31,46 The haplograft would achieve reliable early engraftment, which may contribute to the low incidence of post transplant neutropeniarelated infections and the low rate of NRM.…”

Section: Discussionmentioning

confidence: 65%

Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients

et al. 2017

Bone Marrow Transplant

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The purpose of this study was to evaluate the strategy of haploidentical (HID) stem cell combined with a small doses of umbilical cord blood (UCB) from a third-party donor transplantation (haplo-cord transplant) for treatment of myelodysplastic syndromes (MDS), by comparing with identical-sibling donor (ISD) transplantation. Eighty-five patients were included between January 2012 and December 2015, with a median 40 years old. Forty-eight patients received haplo-cord transplant and 37 patients received ISD transplant. Haplograft engraftment succeeded in all haplo-cord patients. For haplo-cord and ISD transplantation, adjusted cumulative incidences of grades 2-4 acute GvHD at 100 days were 27 and 11% (P=0.059); adjusted cumulative incidences of chronic GvHD at 2 years were 22 and 34% (P=0.215). The 2-year adjusted probabilities of overall survival were 64 and 70% (P=0.518), and of relapse-free survival were 56 and 66% (P=0.306). The 2-year adjusted cumulative incidences of relapse were 12 and 14% (P=0.743), and of non-relapse mortality were 33 and 23% (P=0.291). In conclusion, haplo-cord-HSCT achieves outcomes similar to those of ISD-HSCT for MDS and the haplo-cord-HSCT may potentially improve the outcome of HID- and UCB-HSCT alone. Thus, the haplo-cord transplantation may be a better valid alternative for MDS when an ISD is not available.

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Section: Discussionmentioning

confidence: 65%

Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients

et al. 2017

Bone Marrow Transplant

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“…Ganciclovir was given for 2 weeks pre-transplantation for prophylaxis of CMV infection, and was administered once again when CMV-emia occurred [4]. Preemptive therapy for EBV-emia was according to our previous description [38, 41]. Antifungal agents were administered 5 days pre-transplantation and continued for +30 to +90 days post-transplantation or disease control according to the history and state of IFD pre-transplantation [42].…”

Section: Methodsmentioning

confidence: 99%

Sequential intensified conditioning followed by prophylactic DLI could reduce relapse of refractory acute leukemia after allo-HSCT

et al. 2016

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The major obstacle is leukemia relapse for refractory leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We previously introduced a strategy of sequential intensified conditioning and early rapid immunosupressant withdrawal for refractory leukemia undergoing allo-HSCT, with 5-year overall survival (OS) and 3-year relapse rate of 44.6% and 33.3%. To reduce leukemia relapse, prophylactic donor lymphocyte infusion (DLI) was administered based on our historical strategy. A total of 153 refractory advanced acute leukemia patients were enrolled in this prospective study. According to the availability of donor lymphocytes and the criteria for DLI, 144 patients surviving day +60 were divided into two groups (80 DLI versus 64 non-DLI). The relapse rate was less and OS was better in patients receiving DLI than in those not receiving DLI (22.7% vs 33.9%, P=0.048; 58.1% vs 54.9%, P=0.043). The non-relapse mortality (NRM) was similar between DLI and non-DLI groups (P=0.104). Overall, the 5-year overall and disease-free survival post-transplantation were 51.1%±5.7% and 49.2%±5.3%. The 5-year relapse rate and NRM were 27.3%±4.4% and 29.7%±5.3%. Multivariate analysis revealed that lower bone marrow blasts on day 0, DLI and chronic graft-versus-host disease were associated with less relapse and better OS. The strategy of sequential intensified conditioning followed by early immunosupressant withdrawal and DLI could reduce relapse of refractory acute leukemia after allo-HSCT and improve survival.

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“…11 RIT is often used as prophylaxis for PTLD, particularly in pediatric patients at high risk for PTLD development, including those with severe aplastic anemia after unrelated cord blood transplantation, or after haploidentical HSCT. 12,13 However, RIT use after allogeneic HSCT can deplete both donor and recipient B cells, causes a delay in B-cell immune reconstitution of at least 6 months, 14 and therefore can result in increased incidences of critical cytopenia and infections. 15,16 In the current study, we found that RIT use before HSCT reduced of methylprednisolone, and tacrolimus for the prevention of graft rejection.…”

Section: Discussionmentioning

confidence: 99%

Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab

Fujimoto

Hiramoto

Yamasaki

et al. 2020

Hematological Oncology

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Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B‐cell, T/NK‐cell, and T‐cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B‐cell lymphoma. Thirty‐one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post‐HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio [HR] = 5.6, 95% confidence interval [CI], 1.48‐21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61‐12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26‐7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post‐HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG−), 0.75% (rituximab−, ATG−), 1.25% (rituximab+, ATG+), and 3.53% (rituximab−, ATG+). Regarding lymphoma subtypes, patients with mature B‐cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high‐risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high‐risk patients.

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Molecular monitoring and stepwise preemptive therapy for Epstein–Barr virus viremia after allogeneic stem cell transplantation

Cited by 43 publications

References 37 publications

Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients

Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients

Sequential intensified conditioning followed by prophylactic DLI could reduce relapse of refractory acute leukemia after allo-HSCT

Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab

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