Abstract
e19029 Background: EBV is associated with the majority of cases of PTLD, a serious complication after solid organ and hematopoietic stem cell transplantation. EBV serum viral loads have been used to identify those at risk of this disease in EBV-positive cases. We aimed to characterize the clinical presentation, pathologic diagnosis andprognostic implications of EBV viral load and its response to treatment. Methods: This is a retrospective observational study approved by IRB including all organ transplant patients with histologic diagnosis of PTLD between 2000 and 2018 at Loma Linda University Medical Center. Data was collected by chart review. Kaplan-Meier survival estimates were used to determine primary outcomes of overall survival and progression free survival. Results: 68 patients (41 male, 27 female) were identified who developed PTLD following solid organ transplantation (22 kidney, 37 heart, 6 liver, 3 multi-organ). Median time from transplant to PTLD diagnosis was longest among neonatal transplants 12.0 years versus 3.76 in pediatric and 6.43 in adult transplantations. EBER positive histology was observed in 93% (39/42) of pediatric population versus 52% (12/23) of the adult population. During treatment 16 (23%) experienced acute rejection with 5 (7%) graft losses. The largest subset, monomorphic diffuse large B-cell lymphoma (n = 34), had a median overall survival of 15.1 years. M-DLBCL with high levels of EBV copy load > 10,000 IU/mL had a trend toward worse overall survival of 9.0 versus 15.1 years in < 10,000 IU/mL (HR 2.74, p = 0.14). Treatment resulted in complete serologic EBV copy load response in 15/19 and a trend toward improved overall survival with a median OS not yet reached versus 13.7 years in incomplete responders (HR 0.76, p = 0.76). Conclusions: Our study introduces the hypothesis that initial EBV viral loads and treatment response may have prognostic importance. The characteristics, pathologic diagnosis and treatment response for this cohort of patients will be presented. [Table: see text]
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