Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab
The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/di...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2013-11, Vol.48 (11), p.1465-1471 |
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| creator | van der Velden, W J F M Mori, T Stevens, W B C de Haan, A F J Stelma, F F Blijlevens, N M A Donnelly, J P |
| description | The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/disease and EBV-related mortality among 273 consecutive recipients of a T-cell-depleted allo-SCT during two periods: (a) before the implementation of a comprehensive protocol (2006–2008) and (b) afterwards (2009–2011). EBV infection was detected in 61 (22%) cases, and 28 cases were considered to have had EBV disease. Treatment with antithymocyte globulin was the most important risk factor (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.3–4.2,
P
=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days,
P
=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12%) vs 11/28 (39%),
P
=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6%) vs 8/28 (29%), OR 0.2; 95% CI 0.05–0.9,
P
=0.03). The EBV protocol proved feasible and resulted in faster initiation of pre-emptive therapy, the diagnosis in an earlier stage of EBV disease, and decreased EBV-related mortality. |
| doi_str_mv | 10.1038/bmt.2013.84 |
| format | Article |
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P
=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days,
P
=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12%) vs 11/28 (39%),
P
=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6%) vs 8/28 (29%), OR 0.2; 95% CI 0.05–0.9,
P
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Graft versus host reaction ; Care and treatment ; Cell Biology ; Cohort Studies ; Complications and side effects ; Confidence intervals ; Epstein-Barr virus ; Epstein-Barr Virus Infections - etiology ; Female ; Globulins ; Hematologic and hematopoietic diseases ; Hematology ; Hematopoietic Stem Cell Transplantation - adverse effects ; Hematopoietic Stem Cell Transplantation - methods ; Humans ; Immunosuppressive Agents - administration & dosage ; Immunotherapy ; Infections ; Infectious diseases ; Internal Medicine ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphocytes ; Lymphocytes T ; Lymphoma, B-Cell - etiology ; Lymphoma, B-Cell - prevention & control ; Lymphoma, B-Cell - virology ; Lymphoproliferative Disorders - etiology ; Lymphoproliferative Disorders - prevention & control ; Lymphoproliferative Disorders - virology ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Monoclonal antibodies ; Mortality ; original-article ; Patients ; Polymerase chain reaction ; Posttransplant lymphoproliferative disorders ; Public Health ; Retrospective Studies ; Risk analysis ; Risk factors ; Rituximab ; Stem cell transplantation ; Stem Cells ; Thymocytes ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Treatment Outcome ; Viral diseases]]></subject><ispartof>Bone marrow transplantation (Basingstoke), 2013-11, Vol.48 (11), p.1465-1471</ispartof><rights>Macmillan Publishers Limited 2013</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2013 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Nov 2013</rights><rights>Macmillan Publishers Limited 2013.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c646t-32c92063081fd1184d47865d53f7b338d629e7f9a97e3a92bc66a09dcaa1eb4e3</citedby><cites>FETCH-LOGICAL-c646t-32c92063081fd1184d47865d53f7b338d629e7f9a97e3a92bc66a09dcaa1eb4e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/bmt.2013.84$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/bmt.2013.84$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27960002$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23749107$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Velden, W J F M</creatorcontrib><creatorcontrib>Mori, T</creatorcontrib><creatorcontrib>Stevens, W B C</creatorcontrib><creatorcontrib>de Haan, A F J</creatorcontrib><creatorcontrib>Stelma, F F</creatorcontrib><creatorcontrib>Blijlevens, N M A</creatorcontrib><creatorcontrib>Donnelly, J P</creatorcontrib><title>Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/disease and EBV-related mortality among 273 consecutive recipients of a T-cell-depleted allo-SCT during two periods: (a) before the implementation of a comprehensive protocol (2006–2008) and (b) afterwards (2009–2011). EBV infection was detected in 61 (22%) cases, and 28 cases were considered to have had EBV disease. Treatment with antithymocyte globulin was the most important risk factor (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.3–4.2,
P
=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days,
P
=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12%) vs 11/28 (39%),
P
=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6%) vs 8/28 (29%), OR 0.2; 95% CI 0.05–0.9,
P
=0.03). The EBV protocol proved feasible and resulted in faster initiation of pre-emptive therapy, the diagnosis in an earlier stage of EBV disease, and decreased EBV-related mortality.</description><subject>631/250/1904</subject><subject>692/699/249/1623</subject><subject>692/699/255/2514</subject><subject>692/700/565/1436</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Antibodies, Monoclonal, Murine-Derived - administration & dosage</subject><subject>Antilymphocyte serum</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Blood diseases</subject><subject>Bone marrow</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Care and treatment</subject><subject>Cell Biology</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Confidence intervals</subject><subject>Epstein-Barr virus</subject><subject>Epstein-Barr Virus Infections - etiology</subject><subject>Female</subject><subject>Globulins</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunotherapy</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphocytes</subject><subject>Lymphocytes T</subject><subject>Lymphoma, B-Cell - etiology</subject><subject>Lymphoma, B-Cell - prevention & control</subject><subject>Lymphoma, B-Cell - virology</subject><subject>Lymphoproliferative Disorders - etiology</subject><subject>Lymphoproliferative Disorders - prevention & control</subject><subject>Lymphoproliferative Disorders - virology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Mortality</subject><subject>original-article</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Posttransplant lymphoproliferative disorders</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Rituximab</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Thymocytes</subject><subject>Transfusions. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Antibodies, Monoclonal, Murine-Derived - administration & dosage</topic><topic>Antilymphocyte serum</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Blood diseases</topic><topic>Bone marrow</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Care and treatment</topic><topic>Cell Biology</topic><topic>Cohort Studies</topic><topic>Complications and side effects</topic><topic>Confidence intervals</topic><topic>Epstein-Barr virus</topic><topic>Epstein-Barr Virus Infections - etiology</topic><topic>Female</topic><topic>Globulins</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunotherapy</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Lymphocytes</topic><topic>Lymphocytes T</topic><topic>Lymphoma, B-Cell - etiology</topic><topic>Lymphoma, B-Cell - prevention & control</topic><topic>Lymphoma, B-Cell - virology</topic><topic>Lymphoproliferative Disorders - etiology</topic><topic>Lymphoproliferative Disorders - prevention & control</topic><topic>Lymphoproliferative Disorders - virology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Mortality</topic><topic>original-article</topic><topic>Patients</topic><topic>Polymerase chain reaction</topic><topic>Posttransplant lymphoproliferative disorders</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Rituximab</topic><topic>Stem cell transplantation</topic><topic>Stem Cells</topic><topic>Thymocytes</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation</topic><topic>Treatment Outcome</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Velden, W J F M</creatorcontrib><creatorcontrib>Mori, T</creatorcontrib><creatorcontrib>Stevens, W B C</creatorcontrib><creatorcontrib>de Haan, A F J</creatorcontrib><creatorcontrib>Stelma, F F</creatorcontrib><creatorcontrib>Blijlevens, N M A</creatorcontrib><creatorcontrib>Donnelly, J P</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Bone marrow transplantation (Basingstoke)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Velden, W J F M</au><au>Mori, T</au><au>Stevens, W B C</au><au>de Haan, A F J</au><au>Stelma, F F</au><au>Blijlevens, N M A</au><au>Donnelly, J P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><stitle>Bone Marrow Transplant</stitle><addtitle>Bone Marrow Transplant</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>48</volume><issue>11</issue><spage>1465</spage><epage>1471</epage><pages>1465-1471</pages><issn>0268-3369</issn><eissn>1476-5365</eissn><coden>BMTRE9</coden><abstract>The mortality associated with post-transplant lymphoproliferative disorder (PTLD) induced by EBV infection can be reduced by monitoring EBV by polymerase-chain-reaction and rituximab given pre-emptively. We performed a retrospective analysis of the risk factors for the occurrence of EBV infection/disease and EBV-related mortality among 273 consecutive recipients of a T-cell-depleted allo-SCT during two periods: (a) before the implementation of a comprehensive protocol (2006–2008) and (b) afterwards (2009–2011). EBV infection was detected in 61 (22%) cases, and 28 cases were considered to have had EBV disease. Treatment with antithymocyte globulin was the most important risk factor (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.3–4.2,
P
=0.001). After implementation of the protocol, in patients experiencing EBV infection, pre-emptive therapy was started more often and sooner (median 3 vs 6 days,
P
=0.002). Moreover, there were fewer cases of monomorphic PTLD (4/33 (12%) vs 11/28 (39%),
P
=0.01), and the EBV-related mortality was lower for patients experiencing EBV infection (2/33 (6%) vs 8/28 (29%), OR 0.2; 95% CI 0.05–0.9,
P
=0.03). The EBV protocol proved feasible and resulted in faster initiation of pre-emptive therapy, the diagnosis in an earlier stage of EBV disease, and decreased EBV-related mortality.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>23749107</pmid><doi>10.1038/bmt.2013.84</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-3369 |
| ispartof | Bone marrow transplantation (Basingstoke), 2013-11, Vol.48 (11), p.1465-1471 |
| issn | 0268-3369 1476-5365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1458539679 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Nature Journals Online; EZB-FREE-00999 freely available EZB journals |
| subjects | 631/250/1904 692/699/249/1623 692/699/255/2514 692/700/565/1436 Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibodies, Monoclonal, Murine-Derived - administration & dosage Antilymphocyte serum Antineoplastic Agents - administration & dosage Biological and medical sciences Blood diseases Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Care and treatment Cell Biology Cohort Studies Complications and side effects Confidence intervals Epstein-Barr virus Epstein-Barr Virus Infections - etiology Female Globulins Hematologic and hematopoietic diseases Hematology Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic Stem Cell Transplantation - methods Humans Immunosuppressive Agents - administration & dosage Immunotherapy Infections Infectious diseases Internal Medicine Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphocytes Lymphocytes T Lymphoma, B-Cell - etiology Lymphoma, B-Cell - prevention & control Lymphoma, B-Cell - virology Lymphoproliferative Disorders - etiology Lymphoproliferative Disorders - prevention & control Lymphoproliferative Disorders - virology Male Medical sciences Medicine Medicine & Public Health Middle Aged Monoclonal antibodies Mortality original-article Patients Polymerase chain reaction Posttransplant lymphoproliferative disorders Public Health Retrospective Studies Risk analysis Risk factors Rituximab Stem cell transplantation Stem Cells Thymocytes Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Treatment Outcome Viral diseases |
| title | Reduced PTLD-related mortality in patients experiencing EBV infection following allo-SCT after the introduction of a protocol incorporating pre-emptive rituximab |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T21%3A49%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Reduced%20PTLD-related%20mortality%20in%20patients%20experiencing%20EBV%20infection%20following%20allo-SCT%20after%20the%20introduction%20of%20a%20protocol%20incorporating%20pre-emptive%20rituximab&rft.jtitle=Bone%20marrow%20transplantation%20(Basingstoke)&rft.au=van%20der%20Velden,%20W%20J%20F%20M&rft.date=2013-11-01&rft.volume=48&rft.issue=11&rft.spage=1465&rft.epage=1471&rft.pages=1465-1471&rft.issn=0268-3369&rft.eissn=1476-5365&rft.coden=BMTRE9&rft_id=info:doi/10.1038/bmt.2013.84&rft_dat=%3Cgale_proqu%3EA352040403%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1448797069&rft_id=info:pmid/23749107&rft_galeid=A352040403&rfr_iscdi=true |