title: Prognostic factors and outcome of Epstein-Barr virus DNAemia in high-risk recipients of allogeneic stem cell transplantation treated with preemptive rituximab.
abstract: OBJECTIVE
  This study assessed incidence, predictive factors, and outcome of Epstein-Barr virus (EBV) DNAemia in 100 recipients of allogeneic hematopoietic stem cell transplant. A total of 68 patients received anti-thymocyte globulin before unrelated grafts.
  
  
  RESULTS
  Cumulative incidence of high-load EBV DNAemia defined by levels >10,000 copies/mL was 14% at 12 months. In multivariate analysis, a CD4+ T-lymphocyte count >50 μL at day +30 was the only factor significantly associated with a reduced risk of high-load EBV DNAemia. Thirteen of 16 patients with high viral loads were preemptively treated with rituximab and achieved EBV DNA negativity. Three patients had already developed post-transplant lymphoproliferative disorder (PTLD) at the time of detection of high EBV DNA loads, and they obtained complete response after rituximab infusions and chemotherapy. Patients with high EBV DNA load had a significantly higher transplant-related mortality (TRM) compared with patients with negative or low viral load (54% vs. 16%, P = 0.009) and a trend to lower overall survival (55% vs. 29%, P = 0.060).
  
  
  CONCLUSIONS
  We conclude that CD4+ cell count at day +30 is a predictive factor for EBV DNAemia and may help identify patients requiring closer monitoring. Although only 3% of patients progressed to PTLD and were all successfully managed, EBV reactivation was associated with higher TRM, mainly because of infections.
authors: Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy. patriarca.francesca@aoud.sanita.fvg.it
authors: F
authors: F
authors: Patriarca
authors: M
authors: M
authors: Medeot
authors: M
authors: M
authors: Isola
authors: M L
authors: ML
authors: Battista
authors: A
authors: A
authors: Sperotto
authors: C
authors: C
authors: Pipan
authors: E
authors: E
authors: Toffoletti
authors: M
authors: M
authors: Dozzo
authors: A
authors: A
authors: Michelutti
authors: G
authors: G
authors: Gregoraci
authors: A
authors: A
authors: Geromin
authors: M
authors: M
authors: Cerno
authors: C
authors: C
authors: Savignano
authors: C
authors: C
authors: Rinaldi
authors: F
authors: F
authors: Barbone
authors: R
authors: R
authors: Fanin
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D000069283:Rituximab; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects; D014766:Viremia / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000821:virology; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D004279:DNA, Viral; D000069283:Rituximab