Evolving Patterns of EBV-Associated PTLD After Allogeneic Stem Cell Transplantation: Frequency, Characteristics and Outcomes in a Multicenter GETH-TC Study.

BACKGROUND

Epstein-Barr virus-positive post-transplant lymphoproliferative disorder (EBV + PTLD) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Given evolving transplantation practices, updated data are needed.

OBJECTIVE

Multicenter analysis of PTLD epidemiology, clinical characteristics, and outcomes in Spain.

METHODS

Retrospective study across 17 Spanish transplant centers including all proven/probable EBV+ PTLD cases after allo-SCT from January 2000 to June 2023.

RESULTS

Among 14.568 allo-SCTs, 170 PTLD cases were identified (1.2%) peaking in 2010-2017 (2.0%), versus 0.9% in 2000-2009 and 0.7% in 2018-2023. Median onset was 91 days; 75% occurred within 6 months. Proven cases comprised 67%, mostly diffuse large B-cell lymphoma. Advanced stage occurred in 67%, extranodal disease in 22%. Rituximab ± immunosuppression reduction (ISR) was given to 80%, yielding a 62.4% response rate. Responders had superior survival (2-year OS 73.4% vs. 10.7%). EBV-specific cellular therapies were infrequently used. Median follow-up was 97.8 months; 5-year OS 39.6%, with PTLD causing 49% of deaths. Severe hypoalbuminemia, lack of ISR, and rituximab refractoriness predicted worse survival.

CONCLUSIONS

EBV + PTLD frequency has declined in Spain. Prognosis remains poor for rituximab non-responders, highlighting limited access to EBV-specific cellular therapies as an unmet need.