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Meta-Analysis
. 2021 Mar;100(3):763-777.
doi: 10.1007/s00277-021-04428-9. Epub 2021 Jan 25.

Impact of donor and recipient Epstein-Barr Virus serostatus on outcomes of allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis

Michalina Kołodziejczak  1 , Lidia Gil  2 , Rafael de la Camara  3 , Jan Styczyński  4 ; Infectious Diseases Working Party, European Society for Blood and Marrow Transplantation
Affiliations
Meta-Analysis

Impact of donor and recipient Epstein-Barr Virus serostatus on outcomes of allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis

Michalina Kołodziejczak et al. Ann Hematol. 2021 Mar.

Abstract

Allogeneic hematopoietic cell transplant (allo-HCT) is a potentially curative therapeutic strategy that showed encouraging long-term outcomes in hematological diseases. A number of factors can influence post-transplant clinical outcomes. While Epstein-Barr virus (EBV) constitutes a trigger for development of various adverse conditions, no clinical study yet has been powered to assess the effect of EBV serostatus on the clinical outcomes in allo-HCT population. To systematically summarize and analyze the impact of donor and recipient EBV serostatus on transplant outcomes in allo-HCT recipients, meta-analyses were conducted. Selected endpoints were overall survival (OS), relapse-free survival (RFS), relapse incidence (RI), non-relapse mortality (NRM), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), and de novo cGVHD. Three studies with 26,650 patients, transplanted for acute leukemias, lymphomas, chronic hematological malignancies, or non-malignant hematological diseases were included in the meta-analysis. In the whole population, with a total of 53,300 donors and recipients, the rate of EBV seropositivity was 85.1%, including 86.6% and 83.6% among transplant recipients and healthy donors, respectively. Donor EBV seropositivity increased the risk of cGVHD by 17%, de novo cGVHD by 14%, and aGHVD by 5%. Recipient EBV seropositivity increased the risk of cGVHD by 12%, de novo cGVHD by 17%; increased NRM by 11%, increased RI by 11%, decreased OS by 14%, and decreased RFS by 11%. In performed meta-analyses, donor and recipient EBV seropositivity was found to have a significant impact on transplant outcomes in patients after allo-HCT.

Keywords: EBV; Epstein-Barr virus; GVHD; Graft-versus-host disease; HCT; Hematopoietic cell transplantation; Non-relapse mortality; Overall survival; Relapse incidence; Relapse-free survival.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Individual and summary risk ratios with 95% CIs for the outcome of aGVHD in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 3
Fig. 3
Individual and summary risk ratios with 95% CIs for the outcome of cGVHD in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 4
Fig. 4
Individual and summary risk ratios with 95% CIs for the outcome of de novo cGVHD in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 5
Fig. 5
Individual and summary risk ratios with 95% CIs for the outcome of NRM in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 6
Fig. 6
Individual and summary risk ratios with 95% CIs for the outcome of OS in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 7
Fig. 7
Individual and summary risk ratios with 95% CIs for the outcome of RFS in patients undergoing allogeneic hematopoietic cell transplantation stratified by donor and recipient EBV serostatus
Fig. 8
Fig. 8
Individual and summary risk ratios with 95% CIs for the outcome of RI in patients undergoing hematopoietic allogeneic cell transplantation stratified by donor and recipient EBV serostatus
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