Diagnosis and treatment of posttransplantation lymphoproliferative disease after hematopoietic stem cell transplantation.
Uncontrolled expansion of donor-derived Epstein-Barr virus (EBV)-infected B cells has become a significant problem in recipients of allogeneic hematopoietic stem cell transplantations. Major risk factors for the early development of posttransplantation lymphoproliferative disease include the use of unrelated or HLA-mismatched related donors, selective T-cell depletion of donor marrow, and the use of antithymocyte globulin or monoclonal anti-T-cell antibodies for the prophylaxis and treatment of acute graft-versus-host disease. Over the past few years, the administration of in vitro-generated EBV-specific cytotoxic T cells or anti-B-cell monoclonal antibodies has provided effective options for the prophylaxis or treatment of posttransplantation lymphoproliferative disease. Advances in quantitative polymerase chain reaction-based assays allow both the precise measurement of EBV load in peripheral blood samples and the identification of high-risk patients for early initiation of therapy. A major remaining challenge is to assess the significance of an elevated EBV load posttransplantation and to determine the indications for preemptive treatment.
Wagner
Hans-Joachim
HJ
Center for Gene and Cell Therapy, Baylor College of Medicine, Houston, Texas, USA.
Rooney
Cliona M
CM
Heslop
Helen E
HE
D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016219:Immunotherapy, Adoptive; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014181:Transplantation Immunology
D000912:Antibodies, Neoplasm