Abstract: PO2099
Use of Epstein-Barr Virus (EBV) Cytotoxic T Lymphocyte Therapy in a Kidney Transplant Recipient with EBV-Associated Smooth Muscle Tumors
Session Information
- Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Saranu, Rohan, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Babicz, Richard Samuel, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Jo, Vickie Y., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Nikiforow, Sarah, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
- Chandraker, Anil K., Brigham and Women's Hospital, Boston, Massachusetts, United States
Introduction
Epstein-Barr virus (EBV) is commonly associated with malignancies in transplant recipients, the most frequent being Post-transplant lymphoproliferative disorder. A rare, yet distinct, oncological entity are the EBV-associated smooth muscle tumors (EBV-SMTs). We present the case of multiple, malignant EBV-SMTs in a 34-year-old kidney transplant recipient, and the use of Tabelecleucel (EBV cytotoxic T lymphocyte therapy) as a targeted therapy for these tumors.
Case Description
A 34-year-old female kidney transplant recipient presented with fatigue, anorexia, and nighttime chills. Subsequent lab analysis revealed lymphopenia, elevated creatinine, hypercalcemia and high EBV viral load. PET scan revealed intensely avid FDG liver, splenic and lytic lesions of the left femoral head (Fig.1). Diagnosis of EBV-SMTs was confirmed by immunohistochemistry positive for smooth muscle actin, supporting smooth muscle differentiation (Fig.2), and confirmatory in situ hybridization for EBV-encoded RNA. Patient’s immunosuppression was switched from tacrolimus to sirolimus, and treatment was initiated with Tabelecleucel. At the time of the writing of this report, the patient has completed the first cycle of treatment with Tabelecleucel and is preparing for a second cycle of treatment. The patient’s symptoms have improved significantly and creatinine,calcium and white cell counts have returned to baseline, EBV viral load fell from 4120 to 133 and PET scan showed stabilization of disease. We will continue to report on the patient's progress.
Discussion
EBV-SMTs are rare tumors which can present in a variety of ways and are easily missed. They are typically aggressive, with a poor response to radiation and chemotherapy. Tabelecleucel is an EBV cytoxic T lymphocyte therapy, primarily used in immunosuppressed and stem cell transplant recipients. Use in kidney transplant recipients is promising but requires further investigation to better understand optimal HLA matching of cell lines with recipients and allografts.