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The 2022 Tandem Meetings | Strategies for the management of EBV-PTLD

Susan Prockop, MD, Boston Children’s Hospital, Dana-Farber Cancer Institute, Boston, MA, comments on the treatment of Epstein-Barr-positive post-transplant lymphoproliferative disorder (EBV-PTLD). The standard first-line therapy for EBV-PTLD is rituximab in hematopoietic stem cell transplant (HSCT) recipients. Patients who are refractory to first-line therapy have a poor prognosis. Tabelecleucel, a T-cell therapy targeting EBV-infected cells, is a promising option for these patients. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.

Transcript (edited for clarity)

Recipients of both hematopoietic as well as solid organ transplant are at risk for Epstein-Barr virus-driven post-transplant lymphoproliferative disease which is, essentially, a virally driven malignant disease that happens in the absence of good immune control over the virus. And the standard first-line therapy for patients who have PTLD after hematopoietic transplant is rituximab. And after a solid organ transplant, those patients can tolerate more varied therapy...

Recipients of both hematopoietic as well as solid organ transplant are at risk for Epstein-Barr virus-driven post-transplant lymphoproliferative disease which is, essentially, a virally driven malignant disease that happens in the absence of good immune control over the virus. And the standard first-line therapy for patients who have PTLD after hematopoietic transplant is rituximab. And after a solid organ transplant, those patients can tolerate more varied therapy. And so, increasingly, the standard is reduction in immune suppression, followed sequentially by rituximab, and then chemotherapy if people have disease that fails to respond to rituximab. But, in both patient populations, for people who have disease that fails to respond to that first-line therapy, the median overall survivals are quite low. And in a recent 29 center retrospective analysis that was presented at ASH, it demonstrated a median overall survival of just 0.7 months in hematopoietic transplant recipient with refractory PTLD and 4.1 months in solid organ transplant recipient refractory to PTLD, refractory to first-line therapy. So, it’s really essential that these patients in both populations have alternative therapeutic options. And tabelecleucel is a T-cell therapy that’s been designed specifically to target EBV-infected cells, including EBV-PTLD.

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