Outcome of hematopoietic stem cell transplant for patients with chronic active EBV
| Patient . | EBV+ cells . | Age at Tx, y . | Duration disease before Tx, y . | Previous therapy . | Donor . | Disease status at transplant . | Conditioning . | GVHD prophylaxis . | Donor EBV CTLs posttransplant . | EBV PCR posttransplant . | Outcome, time after transplant . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Transplanted at the NIH Clinical Center | |||||||||||
| 12 | B cell | 58 | 4 | IFNα, IVIG, bortezomib, EPOCH, rituximab, fludarabine, autologous CTLs | 6/6 sibling | Persistent disease | Cyclophosphamide, fludarabine | MTX, CyA | No | PCR−, then +, then − | Alive, 6 years |
| 13 | B cell | 45 | 0.5 | IFNα, EPOCH, rituximab, ganciclovir bortezomib, | 6/6 sibling | Persistent disease | Cyclophosphamide, fludarabine | CyA sirolimus | No | PCR+, then − | Died, 20 days, central pontine myelinolysis, residual B-cell lymphoma, multiorgan failure |
| 16 | B cell | 30 | 1 | IFNα, steroids, EPOCH, rituximab | Sibling/URD | Persistent disease | EPOCH-FR; fludarabine/TBI | CyA, sirolimus, tacrolimus | No | PCR+ | Died, 16 months, residual B-cell lymphoma |
| Transplanted at New York Presbyterian Morgan Stanley Children's Hospital | |||||||||||
| 15 | T cell | 12 | 4 | CHOEP, hyperCVAD, cytarabine, asparaginase, MTX | 5/6 sibling | Persistent disease | Thiotepa, cyclophosphamide, fludarabine | Tacrolimus, MMF | Yes; 2 infusions of 2 × 107/m2 EBV LMP1/2-specific CTLs | PCR− | Alive, 2 years |
| Transplanted at Baylor College of Medicine | |||||||||||
| 9 | B cell | 25 | 8 | Acyclovir, CyA, steroids, etoposide | 6/6 URD | Persistent T-cell lymphoma | Cyclophosphamide /cytarabine /ATG/TBI | CD6/8 T cell depletion, CyA | No | PCR- | Alive, CR 11 years |
| 17 | B cell | 10 | 5 | CyA, steroids, etoposide, rituximab, VAMP, autologous CTLs | 5/6 URD | 4th CR | Busulphan/ cyclophosphamide /cytarabine/campath | CyA | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs | PCR Low positive /negative | Alive, CR 6 years |
| 18 | T cell | 6 | 2 | IVIG, acyclovir, steroids, etoposide, CyA | Syngeneic | Refractory T-cell lymphoma | Busulphan/ cyclophosphamide /alemtuzumab | MTX, Tacrolimus | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs and 6 infusions of 2 × 107/m2 EBV LMP1/LMP2-specific CTLs | PCR+ | Died, 4 years, relapsed T-cell lymphoma |
| 19 | NK cell | 12 | 4 | autologous CTLs | 5/6 URD | Persistent disease | Cyclophosphamide/ cytarabine /alemtuzumab/TBI | MTX, tacrolimus | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs | PCR−, then +, then − | Alive, CR 2 years |
| Patient . | EBV+ cells . | Age at Tx, y . | Duration disease before Tx, y . | Previous therapy . | Donor . | Disease status at transplant . | Conditioning . | GVHD prophylaxis . | Donor EBV CTLs posttransplant . | EBV PCR posttransplant . | Outcome, time after transplant . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Transplanted at the NIH Clinical Center | |||||||||||
| 12 | B cell | 58 | 4 | IFNα, IVIG, bortezomib, EPOCH, rituximab, fludarabine, autologous CTLs | 6/6 sibling | Persistent disease | Cyclophosphamide, fludarabine | MTX, CyA | No | PCR−, then +, then − | Alive, 6 years |
| 13 | B cell | 45 | 0.5 | IFNα, EPOCH, rituximab, ganciclovir bortezomib, | 6/6 sibling | Persistent disease | Cyclophosphamide, fludarabine | CyA sirolimus | No | PCR+, then − | Died, 20 days, central pontine myelinolysis, residual B-cell lymphoma, multiorgan failure |
| 16 | B cell | 30 | 1 | IFNα, steroids, EPOCH, rituximab | Sibling/URD | Persistent disease | EPOCH-FR; fludarabine/TBI | CyA, sirolimus, tacrolimus | No | PCR+ | Died, 16 months, residual B-cell lymphoma |
| Transplanted at New York Presbyterian Morgan Stanley Children's Hospital | |||||||||||
| 15 | T cell | 12 | 4 | CHOEP, hyperCVAD, cytarabine, asparaginase, MTX | 5/6 sibling | Persistent disease | Thiotepa, cyclophosphamide, fludarabine | Tacrolimus, MMF | Yes; 2 infusions of 2 × 107/m2 EBV LMP1/2-specific CTLs | PCR− | Alive, 2 years |
| Transplanted at Baylor College of Medicine | |||||||||||
| 9 | B cell | 25 | 8 | Acyclovir, CyA, steroids, etoposide | 6/6 URD | Persistent T-cell lymphoma | Cyclophosphamide /cytarabine /ATG/TBI | CD6/8 T cell depletion, CyA | No | PCR- | Alive, CR 11 years |
| 17 | B cell | 10 | 5 | CyA, steroids, etoposide, rituximab, VAMP, autologous CTLs | 5/6 URD | 4th CR | Busulphan/ cyclophosphamide /cytarabine/campath | CyA | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs | PCR Low positive /negative | Alive, CR 6 years |
| 18 | T cell | 6 | 2 | IVIG, acyclovir, steroids, etoposide, CyA | Syngeneic | Refractory T-cell lymphoma | Busulphan/ cyclophosphamide /alemtuzumab | MTX, Tacrolimus | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs and 6 infusions of 2 × 107/m2 EBV LMP1/LMP2-specific CTLs | PCR+ | Died, 4 years, relapsed T-cell lymphoma |
| 19 | NK cell | 12 | 4 | autologous CTLs | 5/6 URD | Persistent disease | Cyclophosphamide/ cytarabine /alemtuzumab/TBI | MTX, tacrolimus | Yes; 1 infusion of 2 × 107/m2 EBV-specific CTLs | PCR−, then +, then − | Alive, CR 2 years |
ATG indicates antithymocyte globulin; CHOEP, cyclophosphamide-doxorubicin-vincristine-etoposide-prednisone; CR, complete remission; CTLs, cytotoxic T lymphocytes; CVAD, cyclophosphamide-vincristine-doxorubicin-dexamethasone; CyA, cyclosporine; EPOCH, etoposide-prednisone-vincristine-cyclophosphamide-doxorubicin; FR, fludarabine-rituximab; IVIG, intravenous immunoglobulin; LMP, latent membrane protein; MMF, mycophenolate mofetil; MTX, methotrexate; NK, natural killer; TBI, total body irradiation; TX, transplant; URD, unrelated donor; and VAMP, vincristine-doxorubicin-methotrexate-prednisone.