title: Spectrum of Epstein-Barr virus-associated diseases in recipients of allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Epstein-Barr virus (EBV) infection may result in a spectrum of diseases in recipients of transplant. The aim of this study is to investigate the incidence, clinical characteristics, and prognosis of the spectrum of EBV-associated diseases in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  A total of 263 recipients undergoing allo-HSCT were prospectively enrolled. The blood EBV-DNA loads were regularly monitored by quantitative real-time polymerase chain reaction.
  
  
  RESULTS
  The 3-year cumulative incidence of total EBV-associated diseases, posttransplantation lymphoproliferative diseases (PTLD), EBV fever, and EBV end-organ diseases (pneumonia, encephalitis/myelitis, and hepatitis) were 15.6%±2.5%, 9.9%±2.0%, 3.3%±1.3%, and 3.3%±1.2% (2.2%±1.0%, 1.6%±0.8%, and 0.9%±0.6%), respectively. Fever was the most common symptom of EBV-associated diseases. Patients with PTLD had better response rate to rituximab-based treatments compared with those with EBV end-organ diseases (including PTLD accompanied by EBV end-organ diseases) (P=0.014). The 3-year overall survival was 37.3%±13.7%, 100.0%, and 0.0%±0.0% in patients with PTLD, EBV fever, and EBV end-organ diseases (P=0.001).
  
  
  CONCLUSIONS
  EBV-associated diseases other than PTLD are not rare in the recipients of allo-HSCT. The clinical manifestations of EBV end-organ diseases are similar to PTLD. EBV end-organ diseases had poorer response to rituximab-based therapy compared with PTLD.
authors.affiliation: 1 Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2 Institute of Hematology, Peking University People's Hospital, Beijing, China. 3 Address correspondence to: Qifa Liu, Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China and Xiaojun Huang, Institute of Hematology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xuan
authors.forename: Xinmiao
authors.initials: X
authors.lastname: Jiang
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Fen
authors.initials: F
authors.lastname: Huang
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Fan
authors.forename: Xutao
authors.initials: X
authors.lastname: Guo
authors.forename: Min
authors.initials: M
authors.lastname: Dai
authors.forename: Can
authors.initials: C
authors.lastname: Liu
authors.forename: Guopan
authors.initials: G
authors.lastname: Yu
authors.forename: Xian
authors.initials: X
authors.lastname: Zhang
authors.forename: Meiqing
authors.initials: M
authors.lastname: Wu
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Huang
authors.forename: Qifa
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents