Viral-load and B-lymphocyte monitoring of EBV reactivation after allogeneic hemopoietic SCT in children.
EBV-associated post transplant lymphoproliferative disease (EBV-PTLD) is a life-threatening complication that may occur after hemopoietic SCT. We prospectively screened 80 children on a weekly basis using nested quantitative PCR to evaluate EBV genome copies. EBV viral load <1000 copies per 10(5) PBMC was observed in 63% of transplants, whereas it was between 1000 and 9999 copies per 10(5) PBMC in 13%, and between 10 000 and 19 999 in 10%, with no significant increase in percentage of CD20+ lymphocytes. Viral load reached > or = 20 000 copies per 10(5) PBMC in 14% of patients, and rituximab was administered to 75% of them. None of the patients except one developed a lymphoproliferative disease. Our study found that only 13% of unrelated donor HSCT recipients had a very high risk of EBV-PTLD defined as > or = 20 000 geq per 10(5) PBMC associated with an increase in CD20+ lymphocyte. We suggest that rituximab could be administered in the presence of very high levels of EBV-DNA viral load or in the presence of mid levels of EBV-DNA viral load associated with an increase in the percentage of CD20+ lymphocytes. Through this approach, we significantly reduced the number of patients treated with rituximab, and consequently the acute and chronic adverse events related to this treatment.
Faraci
M
M
Hemopoietic Stem cell Transplant Unit, Hematology-Oncology Department, G Gaslini Children's Research Institute, Genova, Italy. maurafaraci@ospedale-gaslini.ge.it
Caviglia
I
I
Morreale
G
G
Lanino
E
E
Cuzzubbo
D
D
Giardino
S
S
Di Marco
E
E
Cirillo
C
C
Scuderi
F
F
Dallorso
S
S
Terranova
P
P
Moroni
C
C
Castagnola
E
E
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D001402:B-Lymphocytes / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D018655:Lymphocyte Count; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D000069283:Rituximab; D014184:Transplantation, Homologous; D019562:Viral Load; D014775:Virus Activation
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D004279:DNA, Viral; D000069283:Rituximab