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A retrospective analysis on anti-CD20 antibody–treated Epstein–Barr virus–related posttransplantation lymphoproliferative disorder following ATG-based haploidentical T-replete hematopoietic stem cell transplantation

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Abstract

Posttransplantation lymphoproliferation disorder (PTLD) is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). Anti-CD20 antibody is the most widely used antibody to eliminate infected B cells. Few studies have focused on prognostic factors predicting the outcome of EBV (Epstein–Barr virus)-PTLD. We conducted a retrospective analysis of 2571 haplo-HSCTs performed between 2010 and 2017 at the Peking University Institute of Hematology; seventy patients who had been treated with rituximab for PTLD were enrolled. The overall EBV-related PTLD frequency was 3.1%. With a median follow-up time of 365 days (range, 54–2659), the overall survival rate was 51.43% (36/70). The cumulative incidence of EBV-PTLD complete remission with anti-CD20 antibody monotherapy was 68.57% (48/70). EBV-PTLD-related mortality was 11.43% (8/70), while the transplantation-related mortality was 38.57% (27/70). Multivariate analysis showed that a decrease in EBV viral load 1 week after therapy was associated with high response rate of EBV-PTLD (p = 0.007, 0.106 (0.021–0.549)), low PTLD-related mortality (p = 0.010, HR 0.058 (0.007–0.503)), and transplantation-related mortality (p = 0.051, HR 0.441 (0.194–1.003)). For EBV-PTLD patients after haplo-HSCT who received rituximab as first-line therapy, non-decreased EBV viral load 1 week after anti-CD20 therapy could be high risk factor for poor outcomes.

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Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81870140, 81670166, 81873445, 81530046), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (Grant No. 81621001), the Project of Health Collaborative Innovation of Guangzhou City (No. 201704020214), the Scientific Research Foundation for Capital Medicine Development (No. 2018-2-4084), Peking University Clinical Scientist Program (BMU2019LCKXJ003), and the Fundamental Research Funds for the Central Universities.

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  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China

    Xue-Yi Luo, Xiao-Dong Mo, Lan-Ping Xu, Xiao-Hui Zhang, Yu Wang, Kai-Yan Liu, Ying-Jun Chang, Xiang-Yu Zhao & Xiao-Jun Huang

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  1. Xue-Yi Luo
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Correspondence to Xiang-Yu Zhao or Xiao-Jun Huang.

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The study protocol was approved by the ethics committee of Peking University People’s Hospital. Informed consent was obtained in accordance with the Declaration of Helsinki.

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Luo, XY., Mo, XD., Xu, LP. et al. A retrospective analysis on anti-CD20 antibody–treated Epstein–Barr virus–related posttransplantation lymphoproliferative disorder following ATG-based haploidentical T-replete hematopoietic stem cell transplantation. Ann Hematol 99, 2649–2657 (2020). https://doi.org/10.1007/s00277-020-04003-8

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