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The time-dependent effects of early-onset Epstein-Barr viremia on adult acute leukemia patients following allo-HSCT with ATG-containing MAC regimen
Ist Teil von
Annals of hematology, 2021-07, Vol.100 (7), p.1879-1889
Ort / Verlag
Berlin/Heidelberg: Springer Berlin Heidelberg
Erscheinungsjahr
2021
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Epstein-Barr virus (EBV) viremia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The purpose of this study was to evaluate the impacts of early-onset EBV viremia in acute leukemia (AL) patients who underwent allo-HSCT with anti-thymocyte globulin (ATG)-containing myeloablative conditioning (MAC) regimen. Two hundred and ninety-six patients were included between January 2013 and December 2015. In 126 patients (42.6%) who developed early-onset EBV viremia, with a median time of 48 (range 18~99) days after allo-HSCT. The cumulative incidence of EBV viremia at 30 and 90 days after allo-HSCT were 4.1 and 39.9%, respectively. Prognostic analysis showed that the adjusted overall survival in early-EBV
pos
group was significantly lower than early-EBV
neg
group within the first 26.7 months after allo-HSCT [hazard ratio (HR), 1.63,
P
= 0.012], but significantly higher than those afterward (after 26.7 months: HR 0.11,
P
= 0.035); for the adjusted event-free survival, early-EBV
pos
group was significantly inferior in early-EBV
pos
group within the first 10.8 months after transplantation (HR: 1.55,
P
= 0.042), and this adverse effect was not detected any more after 10.8 months (HR: 0.58,
P
= 0.107). Compared with early-EBV
neg
group after adjusting by aGVHD and CMV viremia, HR for death from transplant-related mortality was 2.78-fold higher in patients with early-EBV viremia in piecewise constant Cox analysis (
P
= 0.006), and this adverse effect was not detected any more after the cut-point time (HR: 0.67,
P
= 0.361). No differences in terms of relapse and relapse mortality were observed between early-EBV
pos
and early-EBV
neg
group (
P
> 0.05). In conclusion, the impacts on transplant outcomes of early-EBV viremia were time-dependent, which may help to optimize management strategies for early-EBV viremia after allo-HSCT, especially in AL patients with ATG-containing MAC regimen.