Epstein\u2013Barr virus and cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation in patients with non\u2013Hodgkin lymphoma: the prevalence and impacts on outcomes

Yiyang Ding,Xiang Zhang,Yuhua Ru,Mimi Xu,Caixia Li,Jia Chen,Jinjin Zhu,Yang Xu,Tiemei Song,Lingchuan Guo,Depei Wu,Haiwen Huang,Yuqing Tu,Zhengming Jin

doi:10.1007/s00277-021-04642-5

Abstract

Epstein–Barr virus (EBV) and cytomegalovirus (CMV) reactivations are common complications after allogeneic hematopoietic cell transplantation (allo-HCT), but data focusing on non–Hodgkin lymphoma (NHL) are limited. We retrospectively analyzed the prevalence of EBV and CMV reactivation post-allo-HCT and the impacts on transplant outcomes in 160 NHL patients. The 1-year incidences of EBV and CMV reactivation were 22.58% and 25.55%, respectively. Independent impactors for EBV reactivation were more than 6 lines of chemotherapy (P = 0.030), use of rituximab (P = 0.004), and neutrophil recovery within 30 days post-HCT (P = 0.022). For T-cell lymphoblastic lymphoma patients, the International Prognostic Index (IPI) (P = 0.015) and chronic GVHD (P = 0.001) increased the risk of CMV reactivation. CMV reactivation was independently related to a lower risk of relapse (P = 0.027) but higher transplant-related mortality (TRM) (P = 0.038). Although viral reactivation had no significant impact on overall survival (OS) in the whole cohort, it led to an inferior 2-year OS (67.6% versus 92.5%, P = 0.005) and TRM (20.1% versus 4.7%, P = 0.020) in recipients surviving for more than 180 days. We concluded that EBV and CMV reactivation post-allotransplant still deserved concern particularly in NHL patients with high-risk factors, since it is generally related to a deteriorated prognosis. Large-scale studies are warranted to validate our findings.

Highlights

Patients with relapsed and refractory (R/R) non–Hodgkin lymphoma (NHL) have a dismal prognosis
We concluded that Epstein–Barr virus (EBV) and CMV reactivation post-allotransplant still deserved concern in NHL patients with high-risk factors, since it is generally related to a deteriorated prognosis
The growing proportion of haplo-HCT and antithymocyte globulin (ATG) use increases the risk of virus reactivation after transplantation [25], the impact reactivation in patients survived for more than 180 days after alloHCT. a overall survival (OS) of patients with or without virus reactivation. b Progression-free survival (PFS) of patients with or without virus reactivation. c graft-versus-host disease-free and relapse-free survival (GRFS) of patients with or without virus reactivation. d CIR of patients with or without virus reactivation. e transplant-related mortality (TRM) of patients with or without virus reactivation might be compensated by the advances of anti-virus agents

Summary

Introduction

Patients with relapsed and refractory (R/R) non–Hodgkin lymphoma (NHL) have a dismal prognosis. Despite emerging agents and cellular therapies, allogeneic hematopoietic cell transplantation (allo-HCT) remains an essential modality to attain long-term survival [1,2,3]. Transplant outcomes are impaired by all kinds of complications. Reactivations are frequent complications after allo-HCT that could cause fatal virus-related diseases [4,5,6]. EBV per se has been causally linked to the pathogenesis of several types of NHL [7, 8] or posttransplant lymphoproliferative diseases (PTLDs). The reported incidences fluctuate widely from 0.1 to 63% for EBV [9] and from 30 to 70%

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Conclusion