EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig).
J. Choi, B. Shin, J. Kahwaji, S. Ge, D. Thomas, A. Vo, O. Galera, R. Villicana, A. Peng, S. Jordan, M. Toyoda.
Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Meeting: 2016 American Transplant Congress
Abstract number: B297
Keywords: Highly-sensitized, IVIG, Viral therapy
Session Information
Session Name: Poster Session B: PTLD/Malignancies: All Topics
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: CTLA4Ig is a novel immunosuppressive (IS) which acts through costimulatory blockade of T-cells and obviates the need for calcineurin inhibitor-based IS (CNI-IS). Despite benefits in long-term renal function, the drug is limited to EBV sero(+) pts due to an increased risk for PTLD. Here we explore the relationship between viral sero(+) for EBV & CMV at transplant and the risk for subsequent viremia and PTLD in kidney transplant pts receiving CTLA4Ig- vs. CNI-IS. Methods: EBV and CMV viremia by PCR, and the PTLD incidence were compared in the 2 pt groups. All 39 CTLA4Ig-IS (median 29M treatment) were EBV sero(+), while CMV serology was available in 23/39. All pts were >18 years and received anti-CD25, Thymoglobulin or Alemtuzumab induction, and CMV prophylaxis. Results: The results are shown in the Table. Briefly, The incidence of CMV- and EBV-PCR(+) was significantly greater in sero(-) than sero(+) in both groups. When the results were compared between CTLA4Ig- vs. CNI-IS, a significantly higher rate of CMV-PCR(+) was seen in CTLA4Ig- vs. CNI-IS among sero(-) pts (80% vs. 26%), while no difference were seen in CMV sero(+) pts. In contrast, EBV-PCR(+) was significantly greater in CTLA4Ig- vs. CNI-IS for EBV-sero+ patients (15% vs. 4%). PTLD was observed in 3 CTLA4Ig- vs. 0 in CNI-IS pts. Conclusions: CTLA4Ig inhibits establishment of CMV immunity in CMV sero(-) pts. EBV sero(+) pts treated with CTLA4Ig are at increased risk for EBV-PCR(+) and possibly PTLD. Among sero(+) pts, EBV-PCR(+), but not CMV-PCR(+), was significantly greater in CTLA4Ig- than CNI-IS, suggesting a dichotomy in immune responses to these viruses with EBV sero(+) seemingly not rendering protection in CTLA4Ig-treated pts.
|
CTLA4Ig-IS |
CNI-IS |
p-value: CTLA4Ig vs. CNI |
|||
|
Sero+ |
Sero- |
Sero+ |
Sero- |
Sero+ |
Sero- |
CMV Serology at Tx, n (%) |
18 |
5 |
412 |
145 |
|
|
CMV-PCR >30 copies/PCR, n (%) |
3 (17) |
4 (80)* |
52 (13) |
37 (26)* |
0.615 |
0.007 |
|
|
|
|
|
|
|
EBV Serology at Tx, n (%) |
39 |
0 |
134 |
7 |
|
|
EBV-PCR >30 copies/PCR, n (%) |
6 (15) |
NA |
5 (4) |
3 (43)* |
0.009 |
NA |
PTLD, n (%) |
3 (8) |
NA |
0 (0) |
0 (0) |
0.001 |
NA |
|
*p<0.01: sero+ vs – in each group |
CITATION INFORMATION: Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/ebv-sero-positivity-does-not-reduce-the-risk-for-ebv-viremia-andor-post-transplant-lymphoproliferative-disorder-ptld-in-patients-pts-receiving-belatacept-ctla4ig/. Accessed November 24, 2024.« Back to 2016 American Transplant Congress