Neval E Wareham1, Amanda Mocroft2, Henrik Sengeløv3, Caspar Da Cunha-Bang3, Finn Gustafsson4, Carsten Heilmann5, Martin Iversen4, Nikolai S Kirkby6, Allan Rasmussen7, Søren Schwartz Sørensen8, Jens D Lundgren9. 1. CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Finsencentret, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. neval.ete.wareham@regionh.dk. 2. Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK. 3. Department of Haematology, Rigshospitalet, Copenhagen, Denmark. 4. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 5. Department of Pediatrics, Rigshospitalet, Copenhagen, Denmark. 6. Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark. 7. Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark. 8. Department of Nephrology, Rigshospitalet, Copenhagen, Denmark. 9. CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Finsencentret, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Abstract
PURPOSE: Emerging EBV DNAemia in plasma is considered an early sign of post-transplant lymphoproliferative disorder (PTLD). The aim of this study was to quantify the extent of benefit from screening for EBV DNAemia to detect emerging PTLD among solid organ (SOT) or hematopoietic stem cell transplant recipients (HSCT). METHODS: We used receiver operating characteristic (ROC) curves for assessing ability of models to predict PTLD. Among 2642 recipients transplanted between January 2004 and December 2014, 79 (3%) developed PTLD. RESULTS: EBV DNAemia was observed in 331/1784 recipients (18.6%, 95% CI 16.8-20.4) with measured EBV DNA. The area under the curve (AUC) of the ROC of EBV DNAemia to identify persons with subsequent PTLD was 72% (95% CI, 64-79%) among SOT and 59% (51-68%) among HSCT. Including clinical predictors such as age, gender, transplant year and type, high-risk EBV serostatus, and routine biochemistry in addition to EBV DNAemia increased AUC to 83% (75-90%) among SOT and 84% (79-89%) among HSCT. Among HSCT, including additional factors such as T-cell-depleting treatment, acute graft vs. host disease and donor match increased AUC to 85% (78-91%). CONCLUSIONS: We constructed a model to better predict PTLD compared to EBV DNA screening alone which could have clinical implications.
PURPOSE: Emerging EBV DNAemia in plasma is considered an early sign of post-transplant lymphoproliferative disorder (PTLD). The aim of this study was to quantify the extent of benefit from screening for EBV DNAemia to detect emerging PTLD among solid organ (SOT) or hematopoietic stem cell transplant recipients (HSCT). METHODS: We used receiver operating characteristic (ROC) curves for assessing ability of models to predict PTLD. Among 2642 recipients transplanted between January 2004 and December 2014, 79 (3%) developed PTLD. RESULTS: EBV DNAemia was observed in 331/1784 recipients (18.6%, 95% CI 16.8-20.4) with measured EBV DNA. The area under the curve (AUC) of the ROC of EBV DNAemia to identify persons with subsequent PTLD was 72% (95% CI, 64-79%) among SOT and 59% (51-68%) among HSCT. Including clinical predictors such as age, gender, transplant year and type, high-risk EBV serostatus, and routine biochemistry in addition to EBV DNAemia increased AUC to 83% (75-90%) among SOT and 84% (79-89%) among HSCT. Among HSCT, including additional factors such as T-cell-depleting treatment, acute graft vs. host disease and donor match increased AUC to 85% (78-91%). CONCLUSIONS: We constructed a model to better predict PTLD compared to EBV DNA screening alone which could have clinical implications.
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