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Response to Peggs et al.

Bone Marrow Transplantation volume 31, page 727 (2003)Cite this article

We thank Peggs et al for their experience and views on post-transplant lymphoproliferative disorders (PTLD) following reduced-intensity conditioning regimens. We have now performed 112 reduced-intensity conditioning allografts (56 volunteer unrelated, 56 matched sibling) for myeloid and lymphoid malignancies, using disease-specific conditioning regimens, all containing alemtuzumab (CAMPATH-1H), with no other proven occurrence of PTLD. There is little doubt that the intensely immunosuppressive properties of these transplant regimens expose the recipient to a high risk of a number of viral infections and a risk of EBV-related PTLD.

We agree that the incidence of PTLD in this population appears to be low, and an incidence of approximately 2% is probably appropriate. This probably reflects the profound T- and B-cell depletion produced by alemtuzumab.1,2 Meijer et al recently reviewed the data on the monitoring of EBV viral load in diagnosing EBV-associated PTLD, and in standard conditioning BMT recipients, an increase in EBV viral load often preceded the development of PTLD by weeks, with a concomitant reduction in viral load with successful treatment. The sensitivity and specificity of some cell-free systems were 100%.3 While an increase in EBV-viral load does not invariably lead to PLTD,4 it does identify a high-risk group of patients who will benefit from closer monitoring, and early intervention, for example, by the withdrawal of immunosuppression or treatment with rituximab. The outcome of established aggressive PTLD can be poor5,6,7,8,9 and in order to attempt to improve the outcome for these patients, early intervention is imperative and is also much simpler in therapeutic terms.

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References

  1. Curtis RE, Travis LB, Rowlings PA et al. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study. Blood 1999; 94: 2208–2216.

    CAS  PubMed  Google Scholar 

  2. Hale G, Waldmann H . Risks of developing Epstein–Barr virus-related lymphoproliferative disorders after T-cell-depleted marrow transplants. CAMPATH Users. Blood 1998; 91: 3079–3083.

    CAS  PubMed  Google Scholar 

  3. Meijer E, Dekker AW, Weersink AJ et al. Prevention and treatment of Epstein–Barr virus-associated lymphoproliferative disorders in recipients of bone marrow and solid organ transplants. Br J Haematol 2002; 119: 596–607.

    Article  CAS  PubMed  Google Scholar 

  4. van Esser JWJ, van der Holt B, Meijer E et al. Epstein–Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell-depleted SCT. Blood 2001; 98: 972–978.

    Article  CAS  PubMed  Google Scholar 

  5. Micallef IN, Chhanabhai M, Gascoyne RD et al. Lymphoproliferative disorders following allogeneic bone marrow transplantation: the Vancouver experience. Bone Marrow Transplant 1998; 22: 981–987.

    Article  CAS  PubMed  Google Scholar 

  6. Dotti G, Fiocchi R, Motta T et al. Lymphomas occurring late after solid-organ transplantation: influence of treatment on the clinical outcome. Transplantation 2002; 74: 1095–1102.

    Article  PubMed  Google Scholar 

  7. Leblond V, Dhedin N, Mamzer Bruneel MF et al. Identification of prognostic factors in 61 patients with posttransplantation lymphoproliferative disorders. J Clin Oncol 2001; 19: 772–778.

    Article  CAS  PubMed  Google Scholar 

  8. Jain A, Nalesnik M, Reyes J et al. Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience. Ann Surg 2002; 236: 429–436 (discussion 436–437).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Paranjothi S, Yusen RD, Kraus MD et al. Lymphoproliferative disease after lung transplantation: comparison of presentation and outcome of early and late cases. J Heart Lung Transplant 2001; 20: 1054–1063.

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Haematological Medicine, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

    A Y L Ho, S Devereux, A Pagliuca & G J Mufti

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  1. A Y L Ho
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Ho, A., Devereux, S., Pagliuca, A. et al. Response to Peggs et al.. Bone Marrow Transplant 31, 727 (2003). https://doi.org/10.1038/sj.bmt.1703894

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