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. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: Curr Opin Infect Dis. 2021 Dec 1;34(6):635–645. doi: 10.1097/QCO.0000000000000787

Table 2.

Characteristics of the available strategies to manage PTLD in high-risk HCT and SOT patients

Prophylaxis with
rituximab		 Pre-emptive/treatment
strategy with rituximab		 Pre-emptive/treatment with
third party CTLs		 Prophylaxis with donor-
derived CTLs
General principle Circulating anti-CD20 prevents B-cell proliferation and EBV reactivation Anti-CD20 prevents/treats B-cell/EBV proliferation when EBV DNAemia is rising Third party EBV specific CTLs treat EBV proliferation when EBV DNAemia is rising Donor-derived EBV specific CTLs prevent EBV proliferation
Typical application Administration of rituximab (200mg-375mg/m2) immediately prior to cell infusion/organ donation Following regular (usually weekly) monitoring of EBV DNAemia, pre-emptively treating with 375mg/m2 weekly at a specific threshold to prevent the incidence of PTLD or treat early PTLD Following regular (usually weekly) monitoring of EBV DNAemia, pre-emptively treating with HLA matched third party EBV specific CTLs at a specific threshold to prevent the incidence of PTLD or treat early PTLD Administration of donor-derived EBV specific CTLs following cell infusion/organ donation
Safety concerns Minimal: Increased infection risk from B-cell depletion Minimal: Increased infection risk from B-cell depletion Potential concerns with GVHD/organ rejection, however this has not been proven Potential concerns with GVHD/organ rejection, however this has not been proven
Use of rituximab graphic file with name nihms-1739280-t0001.jpg
Overall estimated cost of therapy graphic file with name nihms-1739280-t0002.jpg
Logistical challenges for application graphic file with name nihms-1739280-t0003.jpg
Level of Evidence in HCT + +++ + +
Level of Evidence in SOT + + + +
Considerations Currently no consensus for EBV assay/sample used and EBV DNAemia threshold to use for pre-emptive treatment Large phase III and expanded access trials in commercial product (Tabelecleucel) pending, not currently FDA approved

HLA matching is not always possible		 Facilities to produce donor-derived EBV CTLs are uncommon

The cost and turnaround time to produce donor-derived CTLs is prohibitive
*

All strategies can be used in conjunction with reduction of immunosuppression following EBV DNAemia monitoring