title: EBV-related disease following haematopoietic stem cell transplantation with reduced intensity conditioning.
abstract: 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.
authors.affiliation: Department of Bone Marrow Transplantation, Great Ormond Street Hospital, NHS Trust, London, UK.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Cohen
authors.forename: Nichola
authors.initials: N
authors.lastname: Cooper
authors.forename: Suparno
authors.initials: S
authors.lastname: Chakrabarti
authors.forename: Kirsty
authors.initials: K
authors.lastname: Thomson
authors.forename: Sujith
authors.initials: S
authors.lastname: Samarasinghe
authors.forename: David
authors.initials: D
authors.lastname: Cubitt
authors.forename: Cathryn
authors.initials: C
authors.lastname: Lloyd
authors.forename: Ann
authors.initials: A
authors.lastname: Woolfrey
authors.forename: Paul
authors.initials: P
authors.lastname: Veys
authors.forename: Persis J
authors.initials: PJ
authors.lastname: Amrolia
mesh_terms: 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*