Backgroud: To evaluate the efficacy of preemptive therapy for preventing EBV related PTLD based on the duration of EBV-emia and the viral loads in the patients undergoing haplo-HSCT, a prospective multicenter study was conducted.
Methods: Rituximab or rituximab followed by adoptive cellular therapy was applied for preemptive therapy if EBV-DNA in blood was positive twice consecutively with a rising trend over one log in virus loads or positive consecutively six times without a dropping trend over one log at least within three weeks or not turning negative consecutively eight times within four weeks.
Results: Of the 408 patients with acute leukemia enrolled in this study, 133 occurred EBV-emia, including 19 PTLD and 6 end-organ diseases. The patients with EBV-emia had inferior three-year overall survival (OS) and higher non-relapse mortality (NRM) to those without EBV-emia (OS: 58.0%±5.0% vs. 71.0%±3.0%, =0.042; NRM: 27.9%±3.9% vs. 18.9%±2.4%, =0.050, respectively). Compared with non-preemptive group, the negative conversion of EBV-emia was significantly higher (100% vs. 76.1%, =0.002) and the three-year incidence of PTLD was markedly lower in preemptive group (1.3% vs. 21.7%, =0.000). The median time from EBV-emia to EBV diseases onset was 15 days and the durative time of EBV-emia was positively correlated with PTLD occurrence (=0.419, =0.024).
Conclusions: Rituximab preemptive therapy could reduce the incidence of PTLD. Earlier preemptive therapy should be advocated once the EBV-emia is positive persistently regardless of EBV-DNA levels (NCT01883180).
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal