The time-dependent effects of early-onset Epstein-Barr viremia on adult acute leukemia patients following allo-HSCT with ATG-containing MAC regimen.

Abstract

Epstein-Barr virus (EBV) viremia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The purpose of this study was to evaluate the impacts of early-onset EBV viremia in acute leukemia (AL) patients who underwent allo-HSCT with anti-thymocyte globulin (ATG)-containing myeloablative conditioning (MAC) regimen. Two hundred and ninety-six patients were included between January 2013 and December 2015. In 126 patients (42.6%) who developed early-onset EBV viremia, with a median time of 48 (range 18~99) days after allo-HSCT. The cumulative incidence of EBV viremia at 30 and 90 days after allo-HSCT were 4.1 and 39.9%, respectively. Prognostic analysis showed that the adjusted overall survival in early-EBVpos group was significantly lower than early-EBVneg group within the first 26.7 months after allo-HSCT [hazard ratio (HR), 1.63, P = 0.012], but significantly higher than those afterward (after 26.7 months: HR 0.11, P = 0.035); for the adjusted event-free survival, early-EBVpos group was significantly inferior in early-EBVpos group within the first 10.8 months after transplantation (HR: 1.55, P = 0.042), and this adverse effect was not detected any more after 10.8 months (HR: 0.58, P = 0.107). Compared with early-EBVneg group after adjusting by aGVHD and CMV viremia, HR for death from transplant-related mortality was 2.78-fold higher in patients with early-EBV viremia in piecewise constant Cox analysis (P = 0.006), and this adverse effect was not detected any more after the cut-point time (HR: 0.67, P = 0.361). No differences in terms of relapse and relapse mortality were observed between early-EBVpos and early-EBVneg group (P > 0.05). In conclusion, the impacts on transplant outcomes of early-EBV viremia were time-dependent, which may help to optimize management strategies for early-EBV viremia after allo-HSCT, especially in AL patients with ATG-containing MAC regimen.

• Authors: Peng Ke, Xinyou Zhang, Songbai Liu, Qian Zhu, Xiao Ma, Feng Chen, Xiaowen Tang, Yue Han, ZhengZheng Fu, Suning Chen, Depei Wu, Huiying Qiu, Jihao Zhou, Xiebing Bao
• Journal: Annals of hematology (Ann Hematol) Vol. 100 Issue 7 Pg. 1879-1889 (Jul 2021) ISSN: 1432-0584 [Electronic] Germany
• PMID: 33885923 (Publication Type: Journal Article)

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents
• Myeloablative Agonists

Topics

• Adult
• Allografts
• Antilymphocyte Serum (adverse effects)
• Cytomegalovirus (drug effects, physiology)
• Cytomegalovirus Infections (complications, virology)
• Epstein-Barr Virus Infections (complications, virology)
• Female
• Graft vs Host Disease (prevention & control)
• Hematopoietic Stem Cell Transplantation
• Herpesvirus 4, Human (drug effects, physiology)
• Histocompatibility
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Leukemia, Myeloid, Acute (complications, therapy)
• Male
• Myeloablative Agonists (adverse effects, therapeutic use)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (complications, therapy)
• Prognosis
• Proportional Hazards Models
• T-Lymphocytes (immunology)
• Time Factors
• Transplantation Conditioning (adverse effects)
• Unrelated Donors
• Viremia (etiology)
• Virus Activation (drug effects)
• Young Adult