The value of EBV DNA in early detection of post-transplant lymphoproliferative disorders among solid organ and hematopoietic stem cell transplant recipients

TY - JOUR

T1 - The value of EBV DNA in early detection of post-transplant lymphoproliferative disorders among solid organ and hematopoietic stem cell transplant recipients

AU - Wareham, Neval E

AU - Mocroft, Amanda

AU - Sengeløv, Henrik

AU - Da Cunha-Bang, Caspar

AU - Gustafsson, Finn

AU - Heilmann, Carsten

AU - Iversen, Martin

AU - Kirkby, Nikolai S

AU - Rasmussen, Allan

AU - Sørensen, Søren Schwartz

AU - Lundgren, Jens D

AU - MATCH in PERSIMUNE study group

PY - 2018/8/1

Y1 - 2018/8/1

N2 - PURPOSE: Emerging EBV DNAemia in plasma is considered an early sign of post-transplant lymphoproliferative disorder (PTLD). The aim of this study was to quantify the extent of benefit from screening for EBV DNAemia to detect emerging PTLD among solid organ (SOT) or hematopoietic stem cell transplant recipients (HSCT).METHODS: We used receiver operating characteristic (ROC) curves for assessing ability of models to predict PTLD. Among 2642 recipients transplanted between January 2004 and December 2014, 79 (3%) developed PTLD.RESULTS: EBV DNAemia was observed in 331/1784 recipients (18.6%, 95% CI 16.8-20.4) with measured EBV DNA. The area under the curve (AUC) of the ROC of EBV DNAemia to identify persons with subsequent PTLD was 72% (95% CI, 64-79%) among SOT and 59% (51-68%) among HSCT. Including clinical predictors such as age, gender, transplant year and type, high-risk EBV serostatus, and routine biochemistry in addition to EBV DNAemia increased AUC to 83% (75-90%) among SOT and 84% (79-89%) among HSCT. Among HSCT, including additional factors such as T-cell-depleting treatment, acute graft vs. host disease and donor match increased AUC to 85% (78-91%).CONCLUSIONS: We constructed a model to better predict PTLD compared to EBV DNA screening alone which could have clinical implications.

AB - PURPOSE: Emerging EBV DNAemia in plasma is considered an early sign of post-transplant lymphoproliferative disorder (PTLD). The aim of this study was to quantify the extent of benefit from screening for EBV DNAemia to detect emerging PTLD among solid organ (SOT) or hematopoietic stem cell transplant recipients (HSCT).METHODS: We used receiver operating characteristic (ROC) curves for assessing ability of models to predict PTLD. Among 2642 recipients transplanted between January 2004 and December 2014, 79 (3%) developed PTLD.RESULTS: EBV DNAemia was observed in 331/1784 recipients (18.6%, 95% CI 16.8-20.4) with measured EBV DNA. The area under the curve (AUC) of the ROC of EBV DNAemia to identify persons with subsequent PTLD was 72% (95% CI, 64-79%) among SOT and 59% (51-68%) among HSCT. Including clinical predictors such as age, gender, transplant year and type, high-risk EBV serostatus, and routine biochemistry in addition to EBV DNAemia increased AUC to 83% (75-90%) among SOT and 84% (79-89%) among HSCT. Among HSCT, including additional factors such as T-cell-depleting treatment, acute graft vs. host disease and donor match increased AUC to 85% (78-91%).CONCLUSIONS: We constructed a model to better predict PTLD compared to EBV DNA screening alone which could have clinical implications.

KW - Adolescent

KW - Adult

KW - Cohort Studies

KW - DNA, Viral/blood

KW - Epstein-Barr Virus Infections/blood

KW - Female

KW - Hematopoietic Stem Cell Transplantation/adverse effects

KW - Herpesvirus 4, Human/genetics

KW - Humans

KW - Incidence

KW - Lymphoproliferative Disorders/blood

KW - Male

KW - Middle Aged

KW - Organ Transplantation/adverse effects

KW - Retrospective Studies

KW - Young Adult

U2 - 10.1007/s00432-018-2674-9

DO - 10.1007/s00432-018-2674-9

M3 - Journal article

C2 - 29804164

SN - 0171-5216

VL - 144

SP - 1569

EP - 1580

JO - Journal of Cancer Research and Clinical Oncology

JF - Journal of Cancer Research and Clinical Oncology

IS - 8

ER -