Submitted March 23, 2006
Accepted June 11, 2006
Marked increased risk of epstein-barr virus-related complications with the addition of anti-thymocyte globulin to a non-myeloablative conditioning prior to unrelated umbilical cord blood transplantation
Claudio G Brunstein*, Daniel J Weisdorf, Todd DeFor, Juliet N Barker, Jakub Tolar, Jo-Anne H van Burik, and John E Wagner
Department of Medicine and Blood and Marrow Transplant Program, University of Minnesota
Blood and Marrow Transplant Program, University of Minnesota
Department of Pediatrics and Blood and Marrow Transplant Program, University of Minnesota
Department of Medicine, University of Minnesota
* Corresponding author; email: bruns072{at}umn.edu.
Umbilical cord blood (UCB) is an increasingly utilized alternative source of hematopoietic stem cells for transplantation for patients who lack a suitable sibling donor. Despite concerns about a possible increased risk of Epstein-Barr Virus (EBV) lymphoproliferative disorder (PTLD) after UCB transplant, early reports documented rates of PTLD comparable to those reported after HLA matched unrelated marrow myeloablative (MA) transplants. To further investigate the incidence of EBV PTLD after UCB transplant and potential risk factors, we evaluated the incidence of EBV-related complications in 335 patients undergoing UCB transplant with a MA or non-myeloablative (NMA) preparative regimen. The incidence of EBV-related complications was a 4.5% overall, 3.3% for MA, and 7% for NMA transplants. However, the incidence of EBV-related complications was significantly higher in a subset of patients treated with a NMA preparative regimen that included anti-thymocyte globulin (ATG) versus those that did not (21% vs. 2%, p<0.01). Nine of 11 patients who developed EBV PTLD received rituximab (anti-CD20 antibody), with the five responders alive and disease free at a median of 26 months. Use of ATG in recipients of a NMA preparative regimen warrants close monitoring for evidence of EBV reactivation and potentially preemptive therapy with rituximab.
