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Post-Transplant Complications

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

Bone Marrow Transplantation volume 49, pages 397–402 (2014)Cite this article

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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.

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Acknowledgements

We thank David Pellicer and Shirley Weiss for data collection and management. JS and GFS conceived the study; JS and MA interpreted the data; JS, MA and MAS wrote the paper; JS performed the statistical analyses; LS, AS and EM performed histopathological, phenotypic and molecular analysis; JLL-H performed EBV PCR tests; LS, IJ, PM, AS, IL, GM, FM, EM, MS, CC, BB, CS, JLL-H and GFS reviewed the manuscript and contributed to the final draft.

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Authors and Affiliations

  1. Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain

    J Sanz, M Arango, L Senent, I Jarque, P Montesinos, A Sempere, I Lorenzo, G Martín, F Moscardó, E Mayordomo, M Salavert, C Cañigral, B Boluda, C Salazar, J L López-Hontangas, M A Sanz & G F Sanz

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  1. J Sanz
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Correspondence to J Sanz.

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Sanz, J., Arango, M., Senent, L. et al. EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases. Bone Marrow Transplant 49, 397–402 (2014). https://doi.org/10.1038/bmt.2013.190

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