title: Controlled Epstein-Barr virus reactivation after allogeneic transplantation is associated with improved survival.
abstract: Epstein-Barr virus reactivation (EBV-R) frequently occurs in patients having allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated the impact of controlled EBV-R on survival of 190 patients (114M/76F, median age: 51 yr, range 18-69), having HSCT for hematological malignancies (105 acute leukemias and myelodysplasias, 71 lymphoproliferative disorders, 14 others). Overall survival (OS) and progression-free survival (PFS) were compared between patients with and without EBV-R. Of 138, patients had reduced-intensity conditioning regimen. Various stem cell sources (141 PB, 33 umbilical cord blood and 16 bone marrow) were used. Patients with EBV-R had longer PFS and OS than those without EBV-R: PFS at 2 yr 69% vs. 51% and at 5 yr 47% vs. 38% (P < 0.04); OS at 2 yr 76% vs. 64% and at 5 yr 63% vs. 47%) (P < 0.001). The use of rituximab had no impact on OS and PFS, but it reduced the intensity of GVHD, despite the fact that TRM was not significantly different between the two groups of patients. So, rituximab may have an additional effect to other factors on PFS and OS. In multivariate analysis, antithymocyte globulin administration was not a significant factor for PFS (P = 0.68) and for OS (P = 0.81). Circulating NK cells were significantly increased by 22% (P = 0.03) in EBV-R patients with no differences for other parameters. Controlled EBV-R in the setting of HSCT is associated with better OS and PFS, with a significant increase in circulating NK cells.
authors.affiliation: Unit for Allogeneic Transplantation, Department of Hematology, CHU de Montpellier, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Auger
authors.forename: Mattea
authors.initials: M
authors.lastname: Orsini
authors.forename: Patrice
authors.initials: P
authors.lastname: Céballos
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Tarik
authors.initials: T
authors.lastname: Kanouni
authors.forename: Bastien
authors.initials: B
authors.lastname: Caumes
authors.forename: Bernard
authors.initials: B
authors.lastname: Klein
authors.forename: Martin
authors.initials: M
authors.lastname: Villalba
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000821:virology*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000821:virology*; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007694:Killer Cells, Natural / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000502:physiology*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Epstein-Barr virus; NK cells; allogeneic stem cell transplantation