EBV-related disease following haematopoietic stem cell transplantation with reduced intensity conditioning.
The use of reduced intensity regimens has decreased early mortality following stem cell transplantation. However, the increased immunosuppression following these protocols results in profound and often prolonged lymphopenia, resulting in an increased incidence of viral reactivation. We and others have observed a high incidence of EBV viraemia and post-transplant lymphoproliferative disease (PTLD) following reduced-intensity conditioning regimens, reflecting the delayed recovery of EBV-specific immunity after such transplants. The clinical and histological features at presentation are similar to that seen after conventional intensity conditioning. Given the increasing use of reduced intensity conditioning (RIC) transplants, we review the risk factors for EBV related disease following transplantation with RIC, the potential for pre-emptive therapy of PTLD based on monitoring EBV viraemia and management options in such patients.
Cohen
Jonathan M
JM
Department of Bone Marrow Transplantation, Great Ormond Street Hospital, NHS Trust, London, UK.
Cooper
Nichola
N
Chakrabarti
Suparno
S
Thomson
Kirsty
K
Samarasinghe
Sujith
S
Cubitt
David
D
Lloyd
Cathryn
C
Woolfrey
Ann
A
Veys
Paul
P
Amrolia
Persis J
PJ
D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D006086:Graft vs Host Disease / Q000276:immunology / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000502:physiology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D019172:Transplantation Conditioning / Q000009:adverse effects*