Cytotoxic T-lymphocyte therapy for post-transplant lymphoproliferative disorder after solid organ transplantation in children

Pediatr Transplant. 2018 Mar;22(2). doi: 10.1111/petr.13133. Epub 2018 Feb 1.

Abstract

EBV-CTL immunotherapy targets EBV antigens expressed by tumor cells in PTLD. Data on outcome of EBV-CTL in pSOT patients are limited. The aim of the study is to describe our experience with allogeneic, third-party EBV-CTL for the treatment of PTLD in pSOT patients in a single tertiary center. Retrospective review was performed of all pSOT patients who received EBV-CTL for PTLD. PTLD was diagnosed using World Health Organization histologic criteria. EBV-CTLs were derived from human leukocyte antigen-typed, EBV-seropositive third-party donors, and cryopreserved and maintained by an accredited national blood transfusion service. Ten patients received EBV-CTL for histologically proven PTLD from 1999 to 2016 following liver (n=5), combined intestinal/liver (n=4), and liver/kidney (n=1) transplantation. PTLD occurred at median age of 40 months (range: 12-144) and median post-transplant interval of 8 months (range: 2-107). Seven had monomorphic, two had polymorphic, and one had Hodgkin-type PTLD. All were of B-cell origin and EBV-positive on histology. EBV-CTL achieved an overall remission rate of 80% (8 of 10). Transient adverse effects included fever, tachycardia, and vomiting. None developed graft-versus-host disease or opportunistic infections. EBV-CTL is an effective treatment for PTLD in pSOT patients, with good remission rate and minimal toxicity.

Keywords: EBV; adoptive cellular immunotherapy; lymphoproliferative disorder; organ transplantation.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Herpesvirus 4, Human / immunology*
  • Humans
  • Immunotherapy / methods*
  • Infant
  • Infant, Newborn
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / therapy*
  • Male
  • Organ Transplantation*
  • Postoperative Complications / immunology
  • Postoperative Complications / therapy*
  • Postoperative Complications / virology
  • Retrospective Studies
  • T-Lymphocytes, Cytotoxic / immunology
  • T-Lymphocytes, Cytotoxic / transplantation*
  • T-Lymphocytes, Cytotoxic / virology
  • Treatment Outcome