Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell--depleted SCT.
Reactivation of the Epstein-Barr virus (EBV) after allogeneic stem cell transplantation (allo-SCT) may evoke a protective cellular immune response or may be complicated by the development of EBV-lymphoproliferative disease (EBV-LPD). So far, very little is known about the incidence, recurrence, and sequelae of EBV reactivation following allo-SCT. EBV reactivation was retrospectively monitored in 85 EBV-seropositive recipients of a T-cell--depleted (TCD) allo-SCT and 65 EBV-seropositive recipients of an unmanipulated allo-SCT. Viral reactivation (more than 50 EBV genome equivalents [gEq]/mL) was monitored frequently by quantitative real-time plasma polymerase chain reaction until day 180 after SCT. Probabilities of developing viral reactivation were high after both unmanipulated and TCD-allogeneic SCT (31% +/- 6% versus 65% +/- 7%, respectively). A high CD34(+) cell number of the graft appeared as a novel significant predictor (P =.001) for EBV reactivation. Recurrent reactivation was observed more frequently in recipients of a TCD graft, and EBV-LPD occurred only after TCD-SCT. High-risk status, TCD, and use of antithymocyte globulin were predictive for developing EBV-LPD. Plasma EBV DNA quantitatively predicted EBV-LPD. The positive and negative predictive values of a viral load of 1000 gEq/mL were, respectively, 39% and 100% after TCD. Treatment-related mortality did not differ significantly between TCD and non-TCD transplants, but the incidence of chronic graft-versus-host disease was significantly less in TCD patients. It is concluded that EBV reactivation occurs frequently after TCD and unmanipulated allo-SCT, especially in recipients of grafts with high CD34(+) cell counts. EBV-LPD, however, occurred only after TCD, and EBV load quantitatively predicted EBV-LPD in recipients of a TCD graft. (Blood. 2001;98:972-978)
van Esser
J W
JW
Department of Hematology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, The Netherlands.
van der Holt
B
B
Meijer
E
E
Niesters
H G
HG
Trenschel
R
R
Thijsen
S F
SF
van Loon
A M
AM
Frassoni
F
F
Bacigalupo
A
A
Schaefer
U W
UW
Osterhaus
A D
AD
Gratama
J W
JW
Löwenberg
B
B
Verdonck
L F
LF
Cornelissen
J J
JJ
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000254:growth & development*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008212:Lymphocyte Depletion / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D008875:Middle Aged; D012307:Risk Factors; D013601:T-Lymphocytes; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
D004279:DNA, Viral