PDF(Pubmed)
Abstract：
UNASSIGNED: Children undergoing allo-HCT are at high risk of EBV-related complications. The objective of the study was to analyze the impact of prophylactic post-transplant rituximab on EBV infection and EBV-PTLD in children after allo-HCT, to determine the risk factors for the development of EBV infection and EBV-PTLD and to determine their outcomes. Additionally, the impact of EBV-driven complications on transplant outcomes was analyzed.
UNASSIGNED: Single center retrospective analysis of EBV-related complications in pediatric population undergoing allo-HCT, based on strategy of prophylaxis with rituximab. Overall 276 consecutive children, including 122 on prophylaxis, were analyzed for EBV-driven complications and transplant outcomes.
UNASSIGNED: Prophylaxis with rituximab resulted in significant reduction of EBV infection (from 35.1% to 20.5%; HR=2.7; p<0.0001), and EBV-PTLD (from 13.0% to 3.3%; HR=0.23; p=0.0045). A trend for improved survival was also observed (HR=0.66; p=0.068), while non-relapse mortality was comparable in both cohorts. The peak value of viral load was a risk factor in the development of EBV-PTLD: 10-fold higher peak viral load in comparison to the baseline 104 copies/mL, caused a 3-fold (HR=3.36; p<0.001) increase in the risk of EBV-PTLD. Rituximab treatment was effective as a preemptive therapy in 91.1%, and in 70.9% in EBV-PTLD. Patients who developed PTLD had dismal 5-year overall survival (29% vs 60%; p<0.001), and an increased risk of relapse (72% vs 35%; p=0.024).
UNASSIGNED: Rituximab for prophylaxis of EBV infection and EBV-PTLD was highly effective in pediatric population. Treatment of EBV-PTLD was successful in 70%, however the occurrence of EBV-PTLD was associated with an increased risk of relapse of primary malignant disease.
UNASSIGNED: Single center retrospective analysis of EBV-related complications in pediatric population undergoing allo-HCT, based on strategy of prophylaxis with rituximab. Overall 276 consecutive children, including 122 on prophylaxis, were analyzed for EBV-driven complications and transplant outcomes.
UNASSIGNED: Prophylaxis with rituximab resulted in significant reduction of EBV infection (from 35.1% to 20.5%; HR=2.7; p<0.0001), and EBV-PTLD (from 13.0% to 3.3%; HR=0.23; p=0.0045). A trend for improved survival was also observed (HR=0.66; p=0.068), while non-relapse mortality was comparable in both cohorts. The peak value of viral load was a risk factor in the development of EBV-PTLD: 10-fold higher peak viral load in comparison to the baseline 104 copies/mL, caused a 3-fold (HR=3.36; p<0.001) increase in the risk of EBV-PTLD. Rituximab treatment was effective as a preemptive therapy in 91.1%, and in 70.9% in EBV-PTLD. Patients who developed PTLD had dismal 5-year overall survival (29% vs 60%; p<0.001), and an increased risk of relapse (72% vs 35%; p=0.024).
UNASSIGNED: Rituximab for prophylaxis of EBV infection and EBV-PTLD was highly effective in pediatric population. Treatment of EBV-PTLD was successful in 70%, however the occurrence of EBV-PTLD was associated with an increased risk of relapse of primary malignant disease.
摘要：
■接受allo-HCT的儿童发生EBV相关并发症的风险很高。该研究的目的是分析预防性移植后利妥昔单抗对allo-HCT后儿童EBV感染和EBV-PTLD的影响，确定发生EBV感染和EBV-PTLD的危险因素并确定其结局。此外,分析了EBV驱动的并发症对移植结局的影响.
■单中心回顾性分析接受allo-HCT的儿科人群中EBV相关并发症，基于利妥昔单抗的预防策略。总共276个连续的孩子，包括关于预防的122，分析EBV驱动的并发症和移植结果。
■利妥昔单抗预防导致EBV感染显着降低（从35.1％降至20.5％；HR=2.7；p<0.0001），和EBV-PTLD（从13.0%到3.3%；HR=0.23；p=0.0045）。也观察到生存率改善的趋势(HR=0.66;p=0.068),而非复发死亡率在两个队列中具有可比性.病毒载量的峰值是EBV-PTLD发展的危险因素：与基线104拷贝/mL相比，病毒载量的峰值高10倍，导致EBV-PTLD风险增加3倍(HR=3.36；p<0.001)。利妥昔单抗治疗作为抢先治疗有效，占91.1%，在EBV-PTLD中占70.9%。发生PTLD的患者5年总生存率惨淡(29%vs60%;p<0.001),复发风险增加（72％vs35％；p=0.024）。
■利妥昔单抗预防EBV感染和EBV-PTLD在儿科人群中非常有效。EBV-PTLD的治疗成功达70%,然而,EBV-PTLD的发生与原发性恶性疾病复发风险增加相关.
■单中心回顾性分析接受allo-HCT的儿科人群中EBV相关并发症，基于利妥昔单抗的预防策略。总共276个连续的孩子，包括关于预防的122，分析EBV驱动的并发症和移植结果。
■利妥昔单抗预防导致EBV感染显着降低（从35.1％降至20.5％；HR=2.7；p<0.0001），和EBV-PTLD（从13.0%到3.3%；HR=0.23；p=0.0045）。也观察到生存率改善的趋势(HR=0.66;p=0.068),而非复发死亡率在两个队列中具有可比性.病毒载量的峰值是EBV-PTLD发展的危险因素：与基线104拷贝/mL相比，病毒载量的峰值高10倍，导致EBV-PTLD风险增加3倍(HR=3.36；p<0.001)。利妥昔单抗治疗作为抢先治疗有效，占91.1%，在EBV-PTLD中占70.9%。发生PTLD的患者5年总生存率惨淡(29%vs60%;p<0.001),复发风险增加（72％vs35％；p=0.024）。
■利妥昔单抗预防EBV感染和EBV-PTLD在儿科人群中非常有效。EBV-PTLD的治疗成功达70%,然而,EBV-PTLD的发生与原发性恶性疾病复发风险增加相关.
