Epstein–Barr virus‐associated post‐transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States

医学 移植后淋巴增生性疾病 免疫抑制 内科学 美罗华 胃肠病学 淋巴增殖性病變 恶性肿瘤 危险系数 入射(几何) 移植 肝移植 免疫学 淋巴瘤 置信区间 物理 光学
作者
Tetsuya Tajima,Olivia M. Martinez,Daniel Bernstein,Scott D. Boyd,Dita Gratzinger,Grant Lum,Kazunari Sasaki,Brent Tan,Clare J. Twist,Kenneth I. Weinberg,Brian Armstrong,Dev M. Desai,George Mazariegos,Clifford Chin,Thomas M. Fishbein,Akin Tekin,Robert S. Venick,Sheri M. Krams,Carlos O. Esquivel
出处
期刊:Pediatric Transplantation [Wiley]
卷期号:28 (4) 被引量:2
标识
DOI:10.1111/petr.14763
摘要

Abstract Background Epstein–Barr virus (EBV)‐associated post‐transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis. Methods The prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre‐transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis. Results The uni−/multivariable competing risk analyses revealed the combination of EBV‐seropositive donor and EBV‐naïve recipient (D+R−) was a significant risk factor for PTLD development (sub‐hazard ratio: 2.79 [1.34–5.78], p = .006) and EBV DNAemia (2.65 [1.72–4.09], p < .001). Patients with D+R− were significantly more associated with monomorphic/polymorphic PTLD than those with the other combinations ( p = .02). Patients with monomorphic/polymorphic PTLD ( n = 21) had significantly more EBV DNAemia than non‐PTLD patients ( p < .001) and an earlier clinical presentation of PTLD than patients with hyperplasias ( p < .001), within 6‐month post‐transplant. Among non‐liver transplant recipients, monomorphic/polymorphic PTLD were significantly more frequent than hyperplasias in patients ≥5 years of age at transplant ( p = .01). Conclusions D+R− is a risk factor for PTLD and EBV DNAemia and associated with the incidence of monomorphic/polymorphic PTLD. Intensive follow‐up of EBV viral load within 6‐month post‐transplant, especially for patients with D+R− and/or non‐liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.
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