The real-time polymerase chain reaction-guided modulation of immunosuppression enables the pre-emptive management of Epstein-Barr virus reactivation after allogeneic haematopoietic stem cell transplantation.
To assess a real-time polymerase chain reaction-based modulation of immunosuppression in patients with an increasing Epstein-Barr virus (EBV) viral load, we studied 79 paediatric allogeneic stem cell transplantations (allo-SCT) performed between January 1998 and December 2003. EBV reactivation was observed in 42 of 79 patients (53%) after a median time of 45 d from allo-SCT: 37 (88%) and five (12%) patients had received the graft from an unrelated and a related donor respectively (P = 0.001). Twenty-eight patients (67%) had a viral load > or =300 genomic copies x10(5) peripheral blood mononuclear cells (PBMC) and antithymocyte globulin was the only factor significantly associated with EBV reactivation (P = 0.001, RR 7.1). Among these 28 patients, immunosuppression was suspended and reduced in 17 and 11 patients respectively. Overall, post-transplant lymphoproliferative disease was diagnosed in one of 79 patients (1%). The pre-emptive modulation of immunosuppression in patients with EBV reactivation and a viral load > or =300 genomic copies x10(5) PBMC did not negatively influence transplant-related mortality, overall survival or event-free survival. In conclusion, EBV reactivation is frequent even in 'low risk' patients and the pre-emptive modulation of immunosuppression enables it to be managed safely, with no significant flare in graft-versus-host disease status.
Cesaro
Simone
S
Clinic of Paediatric Haematology and Oncology, Department of Paediatrics, University of Padova, Italy. simone.cesaro@unipd.it
Murrone
Antonio
A
Mengoli
Carlo
C
Pillon
Marta
M
Biasolo
Maria A
MA
Calore
Elisabetta
E
Tridello
Gloria
G
Varotto
Stefania
S
Alaggio
Rita
R
Zanesco
Luigi
L
Palù
Giorgio
G
Messina
Chiara
C
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000628:therapy / Q000821:virology*; D008297:Male; D011184:Postoperative Period; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014184:Transplantation, Homologous; D019562:Viral Load; D014775:Virus Activation
D004279:DNA, Viral