open access

Vol 12, No 3 (2007)
Untitled
Published online: 2007-05-01
Submitted: 2007-01-17
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Management of Epstein-Barr virus reactivation following allogeneic stem cell transplantation

Arjan C. Lankester
DOI: 10.1016/S1507-1367(10)60052-1
·
Rep Pract Oncol Radiother 2007;12(3):163-165.

open access

Vol 12, No 3 (2007)
Untitled
Published online: 2007-05-01
Submitted: 2007-01-17

Abstract

Background

Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation (allo-SCT) that may progress to life-threatening EBV-lymphoproliferative disease (EBV-LPD).

Aim

To present data relevant to incidence, diagnosis and contemporary management of Epstein-Barr virus (EBV) reactivation in children undergoing allogeneic haematopoietic stem cell transplantation.

Materials/Methods

A review of PubMed references based on evidence-based recommendations and own experience

Results

Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation that may progress to life-threatening EBV-lympho-proliferative disease (EBV-LPD), especially after T-cell depletion in vitro and/or in vivo. Clinical symptoms are frequently lacking in the early stages of EBV reactivation. The introduction of real-time polymerase chain reaction (RQ-PCR) several years ago has provided a powerful tool to monitor EBV reactivation in still asymptomatic allo-SCT recipients and to predict increased risk of developing EBV-LPD. Recently, evidence has been provided that EBV-DNA load guided preemptive treatment with B cell depleting CD20 monoclonal antibodies (Rituximab®) is effective in preventing EBV-LPD in allo-SCT recipients at high risk.

Conclusions

We propose that simultaneous and on-line analysis of both EBV-DNA load and T cell recovery will improve the identification of patients at high risk for EBV-LPD. These patients will probably benefit most from pre-emptive interventions.

Abstract

Background

Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation (allo-SCT) that may progress to life-threatening EBV-lymphoproliferative disease (EBV-LPD).

Aim

To present data relevant to incidence, diagnosis and contemporary management of Epstein-Barr virus (EBV) reactivation in children undergoing allogeneic haematopoietic stem cell transplantation.

Materials/Methods

A review of PubMed references based on evidence-based recommendations and own experience

Results

Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation that may progress to life-threatening EBV-lympho-proliferative disease (EBV-LPD), especially after T-cell depletion in vitro and/or in vivo. Clinical symptoms are frequently lacking in the early stages of EBV reactivation. The introduction of real-time polymerase chain reaction (RQ-PCR) several years ago has provided a powerful tool to monitor EBV reactivation in still asymptomatic allo-SCT recipients and to predict increased risk of developing EBV-LPD. Recently, evidence has been provided that EBV-DNA load guided preemptive treatment with B cell depleting CD20 monoclonal antibodies (Rituximab®) is effective in preventing EBV-LPD in allo-SCT recipients at high risk.

Conclusions

We propose that simultaneous and on-line analysis of both EBV-DNA load and T cell recovery will improve the identification of patients at high risk for EBV-LPD. These patients will probably benefit most from pre-emptive interventions.

Get Citation

Keywords

EBV reactivation; EBV-lymphoproliferative disease; allogeneic HSCT

About this article
Title

Management of Epstein-Barr virus reactivation following allogeneic stem cell transplantation

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 12, No 3 (2007)

Pages

163-165

Published online

2007-05-01

DOI

10.1016/S1507-1367(10)60052-1

Bibliographic record

Rep Pract Oncol Radiother 2007;12(3):163-165.

Keywords

EBV reactivation
EBV-lymphoproliferative disease
allogeneic HSCT

Authors

Arjan C. Lankester

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