title: Features of EBV reactivation after reduced intensity conditioning unrelated umbilical cord blood transplantation.
abstract: This single centre study assessed the incidence, kinetics and predictive factors of EBV reactivation and EBV-related lymphoproliferative diseases (LPD) in 33 consecutive patients who received a reduced intensity conditioning (RIC) before umbilical cord blood transplantation (UCBT). During the first 6 months after UCBT, weekly all patients were DNA-PCR screened in the peripheral blood for EBV reactivation and were clinically monitored for clinical features attributable to EBV. The cumulative incidences of EBV reactivation (defined as an EBV load >1000 EBV copies per 10(5) cells measured at least once during follow-up) at 6 months and 2 years after UCBT were 9 (95% confidence interval (CI), 2-22%) and 17% (95% CI, 6-33%), respectively. In 28 patients (85%), the EBV load remained negative at all times, and none of these patients experienced any sign of LPD. Five patients (15%) experienced at least one EBV reactivation episode. EBV reactivation was observed at a median of 132 days (range, 85-438) after UCBT. Two patients developed EBV-related LPD (cumulative incidence, 6% at 3 years). With a median follow-up of 468 days (range, 92-1277) post UCBT, the OS was 62% at 3 years. Five patients died of disease progression and seven patients died of transplant-related complications, including one case of EBV-related LPD. Univariate analysis did not identify any significant risk factor associated with EBV reactivation. We conclude that patients undergoing RIC UCBT are at risk for EBV reactivation, with the need for close EBV monitoring and the use of preemptive rituximab treatment as some cases may progress to life-threatening LPD.
authors: Service d'Hématologie Clinique, Centre Hospitalier et Universitaire (CHU) de Nantes, Nantes, France.
authors: Z
authors: Z
authors: Peric
authors: X
authors: X
authors: Cahu
authors: P
authors: P
authors: Chevallier
authors: E
authors: E
authors: Brissot
authors: F
authors: F
authors: Malard
authors: T
authors: T
authors: Guillaume
authors: J
authors: J
authors: Delaunay
authors: S
authors: S
authors: Ayari
authors: V
authors: V
authors: Dubruille
authors: S
authors: S
authors: Le Gouill
authors: B
authors: B
authors: Mahé
authors: T
authors: T
authors: Gastinne
authors: N
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authors: Blin
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authors: Saulquin
authors: J-L
authors: JL
authors: Harousseau
authors: P
authors: P
authors: Moreau
authors: M
authors: M
authors: Coste-Burel
authors: B-M
authors: BM
authors: Imbert-Marcille
authors: M
authors: M
authors: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000821:virology*; D005260:Female; D019337:Hematologic Neoplasms / Q000601:surgery / Q000821:virology; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014775:Virus Activation