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

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

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2665-2673
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Lymphoproliferative Disorders
Human Herpesvirus 4
Virus Diseases
L-Lactate Dehydrogenase
Immunosuppression
Histology
Therapeutics
Central Nervous System

Keywords

  • Infection and infectious agents
  • posttransplant lymphoproliferative disorder (PTLD)
  • viral: Epstein-Barr Virus (EBV)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Luskin, M. R., Heil, D. S., Tan, K. S., Choi, S., Stadtmauer, E. A., Schuster, S. J., ... Reshef, R. (2015). The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder. American Journal of Transplantation, 15(10), 2665-2673. https://doi.org/10.1111/ajt.13324

The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder. / Luskin, M. R.; Heil, D. S.; Tan, K. S.; Choi, S.; Stadtmauer, E. A.; Schuster, S. J.; Porter, D. L.; Vonderheide, R. H.; Bagg, A.; Heitjan, D. F.; Tsai, D. E.; Reshef, R.

In: American Journal of Transplantation, Vol. 15, No. 10, 01.10.2015, p. 2665-2673.

Research output: Contribution to journalArticle

Luskin, MR, Heil, DS, Tan, KS, Choi, S, Stadtmauer, EA, Schuster, SJ, Porter, DL, Vonderheide, RH, Bagg, A, Heitjan, DF, Tsai, DE & Reshef, R 2015, 'The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder', American Journal of Transplantation, vol. 15, no. 10, pp. 2665-2673. https://doi.org/10.1111/ajt.13324
Luskin, M. R. ; Heil, D. S. ; Tan, K. S. ; Choi, S. ; Stadtmauer, E. A. ; Schuster, S. J. ; Porter, D. L. ; Vonderheide, R. H. ; Bagg, A. ; Heitjan, D. F. ; Tsai, D. E. ; Reshef, R. / The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder. In: American Journal of Transplantation. 2015 ; Vol. 15, No. 10. pp. 2665-2673.
@article{0ccb618f34ac4464bec82e15d22dc783,
title = "The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder",
abstract = "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.",
keywords = "Infection and infectious agents, posttransplant lymphoproliferative disorder (PTLD), viral: Epstein-Barr Virus (EBV)",
author = "Luskin, {M. R.} and Heil, {D. S.} and Tan, {K. S.} and S. Choi and Stadtmauer, {E. A.} and Schuster, {S. J.} and Porter, {D. L.} and Vonderheide, {R. H.} and A. Bagg and Heitjan, {D. F.} and Tsai, {D. E.} and R. Reshef",
year = "2015",
month = "10",
day = "1",
doi = "10.1111/ajt.13324",
language = "English (US)",
volume = "15",
pages = "2665--2673",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder

AU - Luskin, M. R.

AU - Heil, D. S.

AU - Tan, K. S.

AU - Choi, S.

AU - Stadtmauer, E. A.

AU - Schuster, S. J.

AU - Porter, D. L.

AU - Vonderheide, R. H.

AU - Bagg, A.

AU - Heitjan, D. F.

AU - Tsai, D. E.

AU - Reshef, R.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - 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.

AB - 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.

KW - Infection and infectious agents

KW - posttransplant lymphoproliferative disorder (PTLD)

KW - viral: Epstein-Barr Virus (EBV)

UR - http://www.scopus.com/inward/record.url?scp=84941933313&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941933313&partnerID=8YFLogxK

U2 - 10.1111/ajt.13324

DO - 10.1111/ajt.13324

M3 - Article

C2 - 25988622

AN - SCOPUS:84941933313

VL - 15

SP - 2665

EP - 2673

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 10

ER -