Outcome of treatment of Epstein-Barr virus-related post-transplant lymphoproliferative disorder in hematopoietic stem cell recipients: a comprehensive review of reported cases

Abstract

Post-transplant lymphoproliferative disorder (PTLD) caused by Epstein-Barr virus (EBV) is an important complication in high-risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. Before the current methods of anti-EBV therapy were introduced, the mortality from PTLD after HSCT was >80%. With current approaches the mortality from EBV-PTLD can be significantly reduced. The published literature and meeting abstracts were reviewed to assess the impact of different management strategies against EBV-PTLD. This analysis of reported outcomes indicates that preemptive use of rituximab and EBV-cytotoxic T lymphocytes (CTL) significantly reduced the risk of death due to EBV-PTLD in HSCT recipients with survival rates of 89.7% and 94.1%, respectively. Therapy of established PTLD also reduced the risk of fatal outcome. However, the overall success rates were lower than after preemptive therapy, reaching 63% and 88.2% of total EBV-DNA clearance with rituximab and CTL therapy, respectively. A reduction of immunosuppression and/or donor lymphocyte infusion might also reduce the risk of death due to EBV-PTLD. Although it is difficult to estimate these effects more precisely because of the frequent use of combination therapies, the responses to these modalities can be estimated to be 56.6% and 41.0%, respectively. Finally, chemotherapy seems not to contribute to improved survival of patients with PTLD after HSCT and antiviral agents are not active against PTLD.