1
|
Onishi Y, Onodera K, Fukuhara N, Kato H, Ichikawa S, Fujiwara T, Yokoyama H, Yamada-Fujiwara M, Harigae H. Unrelated cord blood transplantation for adult-onset EBV-associated T-cell and NK-cell lymphoproliferative disorders. Int J Hematol 2022; 115:873-881. [PMID: 35274195 DOI: 10.1007/s12185-022-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
Adult-onset EBV-associated T-cell and NK-cell lymphoproliferative disorders (EBV-T/NK-LPDs) often progress rapidly, and require allogeneic stem cell transplantation early in the course of treatment. Unrelated cord blood transplantation (UCBT) is a readily available option for patients without HLA-matched donors. We retrospectively analyzed the outcomes of 12 UCBT in adult patients with chronic active EBV infection (CAEBV, n = 8), EBV-positive hemophagocytic lymphohistiocytosis following primary EBV infection (n = 2), hydroa vacciniforme-like lymphoproliferative disorder (n = 1), and systemic EBV-positive T-cell lymphoma of childhood (STCLC, n = 1). The median age at transplantation was 31.5 years (range 19-58). At the median follow-up time for survivors, which was 6.3 years (range 0.3-11.3), 3-year overall survival (OS) rates in all patients and 8 CAEBV patients were 68.2% (95% CI 28.6-88.9) and 83.3% (95% CI 27.3-97.5), respectively. Graft failure occurred in 4 of 8 CAEBV patients, requiring a second UCBT to achieve neutrophil engraftment. The cumulative incidence of grade II-IV acute GVHD was 33.3% (95% CI 9.1-60.4%). The EBV-DNA load became undetectable or very low after UCBT in all cases. UCBT may be a promising treatment option for adult-onset EBV-T/NK-LPDs.
Collapse
Affiliation(s)
- Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Koichi Onodera
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Noriko Fukuhara
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Kato
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Satoshi Ichikawa
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tohru Fujiwara
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hisayuki Yokoyama
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Minami Yamada-Fujiwara
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Harigae
- Department of Hematology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
2
|
Fan S, Chen J, Liu Z, Xiao J, Jiang F, Liu X, Sun Y. Efficacy of allogeneic hematopoietic stem cell transplantation with cocktail conditioning regimen for the treatment of pediatric patients with chronic active Epstein-Barr virus: A retrospective observational study. Stem Cells Dev 2021; 31:26-31. [PMID: 34779276 DOI: 10.1089/scd.2021.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) was considered as an only therapeutic strategy for chronic active Epstein-Barr virus (CAEBV) infection with few exceptions, while efficacy of various allo-HSCT conditioning regimens for CAEBV has not been fully investigated yet. This study aimed to compare the effectiveness of cocktail conditioning regimen (CCR)-allo-HSCT with reduced-intensity conditioning regimen (RICR)-allo-HSCT for pediatric patients with CAEBV. Data of a total of 54 children with CAEBV from July 2015 to December 2020, were retrospectively analyzed. Among them, 32 patients received VP16, total body irradiation (TBI), busulfan, fludarabine, cyclophosphamide, and anti-thymocyte globulin (ATG) (CCR1 group), 10 patients received VP16, ara-C, TBI, busulfan, fludarabine, cyclophosphamide, and ATG (CCR2 group), and the remaining 12 patients received VP16, busulfan or melphalan, fludarabine, and ATG with or without ara-C (RICR group). The overall survival (OS), hematopoietic engraftment, the incidence of severe graft-versus-host disease (GVHD), and other parameters were analyzed. After adjusting for potential confounders, CCR1 (hazard ratio (HR): 0.023; 95% confidence interval (CI): 0.001-0.448; P=0.013) and CCR2 (HR: 0.028; 95%CI: 0.002-0.457; P=0.012) were associated with a longer OS than RICR. The use of CCR could markedly improve the engraftment success rate and OS rate compared with RICR for pediatric patients with CAEBV.
Collapse
Affiliation(s)
- Shifen Fan
- Beijing Jingdu Children's Hospital, 586810, Beijing, China;
| | - Jiao Chen
- Beijing Jingdu Children's Hospital, 586810, Beijing, China;
| | - Zhouyang Liu
- Beijing Jingdu Children's Hospital, 586810, Department of Hematology, Beijing, China;
| | - Juan Xiao
- Beijing Jingdu Children's Hospital, 586810, Beijing, China;
| | - Fan Jiang
- Beijing Jingdu Children's Hospital, 586810, Beijing, China;
| | - Xiaomei Liu
- Beijing Jingdu Children's Hospital, 586810, Beijing, China;
| | - Yuan Sun
- Beijing Jingdu Children's Hospital, 586810, Beijing, China, 102208;
| |
Collapse
|
3
|
Hattori N, Yamamoto K, Kawaguchi Y, Fujiwara S, Arai N, Kabasawa N, Tsukamoto H, Uto Y, Yanagisawa K, Saito B, Nakamaki T. Early relapse of severe chronic active Epstein-Barr virus infection with posterior reversible encephalopathy syndrome after reduced intensity stem cell transplantation with umbilical cord blood. Leuk Lymphoma 2016; 57:2448-51. [PMID: 26879589 DOI: 10.3109/10428194.2016.1142081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Norimichi Hattori
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Kohei Yamamoto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Yukiko Kawaguchi
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Shun Fujiwara
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Nana Arai
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Nobuyuki Kabasawa
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Hiroyuki Tsukamoto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Yui Uto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Kouji Yanagisawa
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Bungo Saito
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Tsuyoshi Nakamaki
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| |
Collapse
|
4
|
Saburi M, Ogata M, Satou T, Yoshida N, Nagamatsu K, Nashimoto Y, Moroga Y, Takano K, Kohno K, Shirao K. Successful Cord Blood Stem Cell Transplantation for an Adult Case of Chronic Active Epstein-Barr Virus Infection. Intern Med 2016; 55:3499-3504. [PMID: 27904117 PMCID: PMC5216151 DOI: 10.2169/internalmedicine.55.7432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 41-year-old man was referred to our hospital for treatment of anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. Chronic active Epstein-Barr virus (CAEBV) was diagnosed based on the findings of elevated EBV antibody titers and positive EBV-DNA in the peripheral blood, and cord blood stem cell transplantation (CBT) was performed. The EBV-DNA levels in the blood fell below the limit of detection. His lymphoma relapsed on Day 165 with the appearance of eruptions, which disappeared after the withdrawal of tacrolimus. One year after transplantation, there were no signs of recurrence. This encouraging result suggests that CBT should be considered for adult cases of CAEBV with aggressive clinical manifestations.
Collapse
Affiliation(s)
- Masuho Saburi
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Watanabe S, Okada M, Tokugawa T, Sawada A, Ogawa H, Yoshikawa H. [Recurrence of chronic active Epstein-Barr virus infection presenting with myelopathy after umbilical cord blood transplantation]. Rinsho Shinkeigaku 2014; 54:809-13. [PMID: 25342015 DOI: 10.5692/clinicalneurol.54.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 38-year-old man was admitted to our hospital with neck pain, dysesthesia of both hands, and weakness of the left upper limb. He had been diagnosed with a chronic active Epstein-Barr virus infection (CAEBV) at the age of 34 and had undergone umbilical cord blood transplantation at the age of 37. MRI of the spinal cord revealed an intramedullary hyperintense lesion on T₂-weighted images with gadolinium enhancement. Because his laboratory tests revealed proliferation of CD19(+) lymphocytes in the peripheral blood, and EBV DNA was detected in both peripheral blood and CSF, he was diagnosed as having post-transplant EBV associated lymphoproliferative disease. However, chemotherapy did not alleviate his symptoms. At a later time, quantitative chimerism analysis of his CSF showed a higher proportion of lymphocytes that had originated from the recipient. Finally, he was diagnosed as having a recurrence of CAEBV in the central nervous system, and his symptoms were restored by intrathecal chemotherapy (methotrexate, cytosine arabinoside, and prednisolone). Quantitative chimerism analysis of CSF was useful for diagnosing the recurrence of CAEBV in the central nervous system.
Collapse
Affiliation(s)
- Shohei Watanabe
- Department of Internal Medicine, Division of Neurology, Hyogo College of Medicine
| | | | | | | | | | | |
Collapse
|
6
|
Characterization and treatment of chronic active Epstein-Barr virus disease: a 28-year experience in the United States. Blood 2011; 117:5835-49. [PMID: 21454450 DOI: 10.1182/blood-2010-11-316745] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic active EBV disease (CAEBV) is a lymphoproliferative disorder characterized by markedly elevated levels of antibody to EBV or EBV DNA in the blood and EBV RNA or protein in lymphocytes in tissues. We present our experience with CAEBV during the last 28 years, including the first 8 cases treated with hematopoietic stem cell transplantation in the United States. Most cases of CAEBV have been reported from Japan. Unlike CAEBV in Japan, where EBV is nearly always found in T or natural killer (NK) cells in tissues, EBV was usually detected in B cells in tissues from our patients. Most patients presented with lymphadenopathy and splenomegaly; fever, hepatitis, and pancytopenia were common. Most patients died of infection or progressive lymphoproliferation. Unlike cases reported from Japan, our patients often showed a progressive loss of B cells and hypogammaglobulinemia. Although patients with CAEBV from Japan have normal or increased numbers of NK cells, many of our patients had reduced NK-cell numbers. Although immunosuppressive agents, rituximab, autologous cytotoxic T cells, or cytotoxic chemotherapy often resulted in short-term remissions, they were not curative. Hematopoietic stem cell transplantation was often curative for CAEBV, even in patients with active lymphoproliferative disease that was unresponsive to chemotherapy. These studies are registered at http://www.clinicaltrials.gov as NCT00032513 for CAEBV, NCT00062868 and NCT00058812 for EBV-specific T-cell studies, and NCT00578539 for the hematopoietic stem cell transplantation protocol.
Collapse
|
7
|
Gotoh K, Ito Y, Shibata-Watanabe Y, Kawada JI, Takahashi Y, Yagasaki H, Kojima S, Nishiyama Y, Kimura H. Clinical and virological characteristics of 15 patients with chronic active Epstein-Barr virus infection treated with hematopoietic stem cell transplantation. Clin Infect Dis 2008; 46:1525-34. [PMID: 18419486 DOI: 10.1086/587671] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Chronic active Epstein-Barr virus (EBV) infection is characterized by recurrent infectious mononucleosis-like symptoms, and infected patients have high viral loads in their peripheral blood. Standard therapy for the disease has not yet been established. Recently, hematopoietic stem cell transplantation (HSCT) has been introduced and has the potential to become a standard treatment, although guidelines for HSCT to treat chronic active EBV infection have not yet been proposed. METHODS Fifteen patients were retrospectively analyzed, both clinically and virologically, to investigate the factors associated with prognosis of chronic active EBV infection treated with HSCT. RESULTS After HSCT, 7 patients died after survival periods that ranged from 1 to 16 months (mean duration of survival after HSCT, 5 months). Three patients were considered to have died of transplantation-related complications. The duration between infection onset and diagnosis was significantly longer in patients who died than in those who survived. Five of the 7 patients who died experienced > or =3 life-threatening complications. The plasma concentrations of interferon-gamma, interleukin-10, thrombomodulin, and soluble E-selectin did not differ significantly between the groups of patients. With regard to sequence variations in the EBV latent membrane protein 1 gene, no specific patterns were found in the patients who died. Importantly, the plasma EBV load at diagnosis was significantly higher in patients who died than in living patients. Moreover, plasma viral load was shown to be an important factor to monitor during follow-up for patients after HSCT. CONCLUSIONS The number of life-threatening complications and plasma viral load are indicative of the stage of disease progression and may be useful factors for predicting the outcome of HSCT.
Collapse
Affiliation(s)
- Kensei Gotoh
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Tokuhira M, Iizuka A, Watanabe R, Sekiguchi N, Sato N, Chien CK, Sekiguchi Y, Nemoto T, Hanzawa K, Tamaru JI, Itoyama S, Suzuki H, Takeuchi T, Mori S, Kizaki M. Severe degenerative change of multiple organs mediated by chronic active Epstein–Barr virus infection with infected T-cell expansion. Int J Hematol 2008; 87:520-526. [DOI: 10.1007/s12185-008-0069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 02/20/2008] [Accepted: 02/21/2008] [Indexed: 11/25/2022]
|