title: Epstein-Barr virus reactivation in allogeneic stem cell transplantation is highly related to cytomegalovirus reactivation.
abstract: Monitoring of Epstein-Barr virus (EBV) load and pre-emptive rituximab is an appropriate approach to prevent post-transplant lymphoproliferative disease (PTLD) occurring after hematopoietic stem cell transplantation (HSCT). This pre-emptive approach, based on EBV-DNA monitoring through a quantitative polymerase chain reaction, was applied to 101 consecutive patients who underwent allo HSCT at our Institute (median age 50). A single infusion of rituximab was administered to 11 of 16 patients who were at high risk for progression to PTLD, defined as a DNA value >10 000 copies/mL. All patients cleared EBV DNAemia, without any recurrences. Main factors significantly associated with high risk for PTLD were as follows: (i) unrelated vs. sibling (26% vs. 7%; p = 0.011); (ii) T-cell depletion (29% vs. 6%; p = 0.001); (iii) graft versus host disease (GVHD; 30% vs. 7%; p = 0.002); and (iv) cytomegalovirus (CMV) reactivation (29% vs. 4%; p = 0.001). Multivariate analysis showed that CMV reactivation was the only independent variable associated with EBV reactivation. We conclude that: (i) a single infusion of rituximab is able to prevent the risk of progression into EBV-related PTLD; and (ii) CMV reactivation is strongly associated with EBV reactivation; therefore, an intensive EBV monitoring strategy could be advisable only in case of CMV reactivation.
authors.affiliation: Department of Hematology, SS Antonio e Biagio Hospital, Alessandria, Italy. fazallio@ospedale.al.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Zallio
authors.forename: Valeria
authors.initials: V
authors.lastname: Primon
authors.forename: Stefania
authors.initials: S
authors.lastname: Tamiazzo
authors.forename: Massimo
authors.initials: M
authors.lastname: Pini
authors.forename: Anna
authors.initials: A
authors.lastname: Baraldi
authors.forename: Maria T
authors.initials: MT
authors.lastname: Corsetti
authors.forename: Franca
authors.initials: F
authors.lastname: Gotta
authors.forename: Claudia
authors.initials: C
authors.lastname: Bertassello
authors.forename: Flavia
authors.initials: F
authors.lastname: Salvi
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D000069283:Rituximab; D014184:Transplantation, Homologous; D014775:Virus Activation; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D004279:DNA, Viral; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Epstein-Barr virus; cytomegalovirus; hematopoietic stem cell transplantation; post-transplant lymphoproliferative disease; rituximab