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- W1974949955 abstract "EBV lymphomas (EBV-L) arising post HSCT that persist or recur following Rituxan therapy are often fatal. We analyzed treatment with EBV-specific T-cells (EBV-CTL) in 22 patients (pts) who developed EBV-L following HLA-matched (N=8) or non-identical N=11 T cell depleted (N=17) or unmodified (N=3) HSCT or cord blood grafts (N=3). All pts had clinical and radiologic evidence of rapidly growing tumors of Waldeyer's ring and/or intestines, liver, lung or CNS and rising blood levels of EBV DNA. Biopsies showed B cell, EBV+ lymphoma in 20 pts that were monoclonal (12/12 tested) and usually of donor origin (11/12 tested). Of 22 pts, 14 had failed (N=10) or recurred (N=4) following Rituxan treatment. EBV-CTL were grown from donor T-cells sensitized with autologous EBVBLCL transformed by EBV strain B95.8 (B95.8 EBVBLCL) and tested for specificity, lack of alloreactivity and sterility. Treatment included 3 weekly infusions of EBV-CTL (106 T cells/kg/Dose). Tumor responses, EBV DNA levels and quantitations of tetramer+, IFNγ+ EBV-specific T-cells and EBV CTLp by limiting dilution analysis (LDA) were monitored. Infusions were well tolerated; no pt developed GVHD. Of the 22 pts, 3 died too early to be evaluated (<10 days). Of 6 pts primarily treated with EBV-CTL, 5 (83%) achieved CR, versus 7/13 (53%) who failed Rituxan. The CR rate was similar in pts on no immunosuppressives or on Sirolimus or Calcineurin inhibitors alone (75% with; 67% without), but was lower for pts on steroids for GVHD or cerebral edema (33%) than for pts off steroids (69%). Pts with single sites of disease fared better than pts with multiple sites (75% vs. 42% CR). However, all sites of disease, including CNS, were comparably responsive to therapy. CTLp frequencies rose 10-200 fold by 2-3 weeks post infusion in pts achieving CR and were temporally associated with disease regression and clearance of EBV DNA. Such increases were not seen in any pt with PD. EBV CTLs inducing CRs in 8 pts studied lysed both B95.8 EBVBLCL and spontaneous EBV+ BLCL transformants (S-EBV BLCL) isolated from the pt's blood or involved tissues; EBV CTL given to 3 non-responders on no immunosuppression lysed B95.8+ BLCL, but not S-EBVBLCL of donor origin isolated from the pt. While EBVCTL can induce durable remissions of EBV lymphoma post HSCT, efficacy may be compromised in Rituxan refractory disease, by ongoing steroid treatment or by failure of the EBVCTL to recognize the endogenous EBV the pt's lymphoma." @default.
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- W1974949955 date "2010-02-01" @default.
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- W1974949955 title "Adoptive Transfer Of EBV Specific T-Cells For Treatment Of Primary And Rituxan Resistant EBV Lymphomas Following Allogeneic Stem Cell Transplants (HSCT): Clinical, Viral And Immunologic Corelates" @default.
- W1974949955 doi "https://doi.org/10.1016/j.bbmt.2009.12.205" @default.
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