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Post-Transplant Events

High incidence of post transplant lymphoproliferative disorder after antithymocyte globulin-based conditioning and ineffective prediction by day 28 EBV-specific T lymphocyte counts

Bone Marrow Transplantation volume 46, pages 1104–1112 (2011)Cite this article

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Abstract

The largest study on post-allogeneic hematopoietic cell transplant lymphoproliferative disorder (PTLD) epidemiology showed a cumulative incidence of 1.7% in patients receiving antithymocyte globulin (ATG). We had noted an apparently higher incidence in our transplant recipients whose conditioning included ATG. Therefore, we formally determined the incidence of PTLD through chart review. We also evaluated whether counts of EBV-specific T lymphocytes measured by cytokine flow cytometry could identify patients at risk of developing PTLD. Among 307 allogeneic transplant recipients, 25 (8.1%) developed PTLD. This was biopsy proven in 11 patients, and was fatal in seven patients. Patient age, EBV serostatus, donor type/match or GVHD did not influence PTLD risk significantly. Median onset of PTLD was 55 (range, 28–770) days post transplant. Day 28 EBV-specific T lymphocyte counts were not significantly different in 11 patients who developed PTLD and 31 non-PTLD patients matched for published risk factors for PTLD. In summary, when using conditioning with thymoglobulin 4.5 mg/kg, the incidence of PTLD is relatively high and cannot be predicted by day 28 cytokine flow cytometry-determined EBV-specific T lymphocyte counts. Thus, in this scenario PTLD prevention may be warranted, for example, using EBV DNAemia monitoring with preemptive therapy.

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Acknowledgements

We thank the patients for participating in research that could not benefit them but only future patients. This study could not happen without the dedication of Polly Louie, Lynne Fisk, Judy Wu, Diana Quinlan, Maggie Yang, Glennis Doiron, Dr Doug Demetrick as well as the staff of the Alberta Blood and Marrow Transplant Program, including in-patient and outpatient nurses and physicians, including Drs Ahsan Chaudhry, Nancy Zacarias, Ping Yue, Nizar Bahlis, Chris Brown, Lynn Savoie, Mona Shafey, Loree Larratt and Robert Turner. We also appreciate help from Tyler S Williamson (statistician) and Dr Raymong Tellier and Xiao-Li Pang of Alberta Provincial Laboratory. This work was funded by Alberta Heritage Foundation for Medical Research, Canada Research Chair Program, Alberta Cancer Research Institute and the University of Calgary O’Brien Centre.

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  1. University of Calgary and Alberta Health Services, Calgary, Alberta, Canada

    M Hoegh-Petersen, D Goodyear, M N Geddes, S Liu, A Ugarte-Torres, Y Liu, J T Walker, K Fonseca, A Daly, P Duggan, D Stewart, J A Russell & J Storek

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Hoegh-Petersen, M., Goodyear, D., Geddes, M. et al. High incidence of post transplant lymphoproliferative disorder after antithymocyte globulin-based conditioning and ineffective prediction by day 28 EBV-specific T lymphocyte counts. Bone Marrow Transplant 46, 1104–1112 (2011). https://doi.org/10.1038/bmt.2010.272

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