The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder

• DOI: 10.1111/ajt.13324
• Publication Date: 2015-05-18T19:28:08Z
• Authors: M.R. Luskin; D.S. Heil; K.S. Tan; S. Choi; E.A. Stadtmauer; S.J. Schuster; D.L. Porter; R.H. Vonderheide; A. Bagg; D.F. Heitjan; D.E. Tsai; R. Reshef
• Keywords: Adult; Aged, 80 and over; Male; Epstein-Barr Virus Infections; Adolescent; Infant; Organ Transplantation; Middle Aged; Prognosis; Lymphoproliferative Disorders; 3. Good health; 03 medical and health sciences; Cross-Sectional Studies; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Risk Factors; Child, Preschool; Humans; Female; Child; Aged; Retrospective Studies

We examined the associations of Epstein-Barr virus (EBV) status with characteristics and outcomes of posttransplantation lymphoproliferative disorder (PTLD) by studying 176 adult solid organ transplant recipients diagnosed with PTLD between 1990 and 2013 (58 [33%] EBV-negative; 118 [67%] EBV-positive). The proportion of EBV-negative cases increased over time from 10% (1990-1995) to 48% (2008-2013) (p < 0.001). EBV-negative PTLD had distinct characteristics (monomorphic histology, longer latency) though high-risk features (advanced stage, older age, high lactate dehydrogenase, central nervous system involvement) were not more common compared to EBV-positive PTLD. In multivariable analysis, EBV negativity was not significantly associated with worse response to initial therapy (adjusted odds ratio, 0.84; p = 0.75). The likelihood of achieving a complete remission (CR) was not significantly different for EBV-negative versus EBV-positive PTLD including when therapy was reduction of immunosuppression alone (35% vs. 43%, respectively, p = 0.60) or rituximab (43% vs. 47%, p = 1.0). EBV negativity was also not associated with worse overall survival (adjusted hazard ratio, 0.91; p = 0.71). Our findings indicate that EBV status is not prognostic or predictive of treatment response in adults with PTLD. The high proportion of EBV-negative disease diagnosed in recent years highlights the need for new strategies for prevention and management of EBV-negative PTLD.