title: Chronic high Epstein-Barr viral load state and risk for late-onset posttransplant lymphoproliferative disease/lymphoma in children.
abstract: Increased use of serial EBV-PCR monitoring after pediatric transplantation has led to the identification of asymptomatic patients who carry very high viral loads over prolonged periods. The significance of this high-load state is unknown. We speculated that this state may identify patients at high risk for development of late PTLD/lymphoma. We reviewed data on 71 pediatric heart recipients who had serial viral load monitoring since 1997. Chronic high-load state was defined as the presence of >16,000 genome copies/mL whole blood on > or =50% of samples over at least 6 months. Among 20 high-load carriers (eight following prior PTLD, seven with prior symptomatic EBV infection, five without previous EBV disease), 9 (45%) developed late-onset PTLD 2.5-8.4 years posttransplant (including with four Burkitt's lymphoma). Among 51 controls with low (n = 39) or absent (n = 12) loads, only 2 (4%; p < 0.001 absent/low vs. high load) developed late PTLD/lymphoma. By multivariable analysis, high-load carrier state (OR = 12.4, 95% CI 2.1-74.4) and prior history of PTLD (OR = 10.7, 95% CI 1.9-60.6) independently predicted late PTLD. A chronic high EBV-load state is not benign and is a predictor of de novo or recurrent PTLD.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Bingler
authors.forename: B
authors.initials: B
authors.lastname: Feingold
authors.forename: S A
authors.initials: SA
authors.lastname: Miller
authors.forename: E
authors.initials: E
authors.lastname: Quivers
authors.forename: M G
authors.initials: MG
authors.lastname: Michaels
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.forename: R M
authors.initials: RM
authors.lastname: Wadowsky
authors.forename: D T
authors.initials: DT
authors.lastname: Rowe
authors.forename: S A
authors.initials: SA
authors.lastname: Webber
mesh_terms: D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008223:Lymphoma / Q000453:epidemiology* / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D012367:RNA, Viral