title: Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation.
abstract: This single centre study assessed the incidence, kinetics and predictive factors of Epstein-Barr Virus (EBV) reactivation and EBV-related lymphoproliferative diseases (LPDs) in 175 consecutive patients who received a reduced-intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT). The cumulative incidence of EBV reactivation at 6 months after allo-HSCT defined as an EBV PCR load above 1000 copies of EBV DNA/10(5) cells was 15%, and none of these patients experienced any sign or symptom of LPD. A total of 17 patients, who had EBV DNA levels exceeding 1000 copies/10(5) cells on two or more occasions, were pre-emptively treated with rituximab. With a median follow-up of 655 (range, 92-1542) days post allo-HSCT, there was no statistically significant difference in term of outcome between those patients who experienced an EBV reactivation and those who did not. In multivariate analysis, the use of antithymocyte globulin as part of the RIC regimen was the only independent risk factor associated with EBV reactivation (relative risk=4.9; 95% confidence interval, 1.1-21.0; P=0.03). We conclude that patients undergoing RIC allo-HSCT using anti-thymocyte globulin as part of the preparative regimen are at higher risk for EBV reactivation. However, this did not impact on outcome, as quantitative monitoring of EBV viral load by PCR and preemptive rituximab therapy allowed for significantly reducing the risk of EBV-related LPD.
authors.affiliation: Centre Hospitalier et Universitaire (CHU) de Nantes, Service d'Hématologie Clinique, Nantes, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Peric
authors.forename: X
authors.initials: X
authors.lastname: Cahu
authors.forename: P
authors.initials: P
authors.lastname: Chevallier
authors.forename: E
authors.initials: E
authors.lastname: Brissot
authors.forename: F
authors.initials: F
authors.lastname: Malard
authors.forename: T
authors.initials: T
authors.lastname: Guillaume
authors.forename: J
authors.initials: J
authors.lastname: Delaunay
authors.forename: S
authors.initials: S
authors.lastname: Ayari
authors.forename: V
authors.initials: V
authors.lastname: Dubruille
authors.forename: S
authors.initials: S
authors.lastname: Le Gouill
authors.forename: B
authors.initials: B
authors.lastname: Mahe
authors.forename: T
authors.initials: T
authors.lastname: Gastinne
authors.forename: N
authors.initials: N
authors.lastname: Blin
authors.forename: B
authors.initials: B
authors.lastname: Saulquin
authors.forename: J-L
authors.initials: JL
authors.lastname: Harousseau
authors.forename: P
authors.initials: P
authors.lastname: Moreau
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: M
authors.initials: M
authors.lastname: Coste-Burel
authors.forename: B-M
authors.initials: BM
authors.lastname: Imbert-Marcille
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000821:virology; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D019562:Viral Load / Q000187:drug effects; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D000069283:Rituximab