Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative.

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Presentation transcript:

Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell–depleted SCT by Joost W. J. van Esser, Bronno van der Holt, Ellen Meijer, Hubert G. M. Niesters, Rudolf Trenschel, Steven F. T. Thijsen, Anton M. van Loon, Francesco Frassoni, Andrea Bacigalupo, Ulrich W. Schaefer, Albert D. M. E. Osterhaus, Jan Willem Gratama, Bob Löwenberg, Leo F. Verdonck, and Jan J. Cornelissen Blood Volume 98(4):972-978 August 15, 2001 ©2001 by American Society of Hematology

Incidence of EBV reactivation Incidence of EBV reactivation.Incidence of EBV reactivation after TCD-allogeneic SCT with ATG (n = 24), TCD-SCT without ATG (n = 61), and non–TCD-SCT (n = 65). Incidence of EBV reactivation.Incidence of EBV reactivation after TCD-allogeneic SCT with ATG (n = 24), TCD-SCT without ATG (n = 61), and non–TCD-SCT (n = 65). Only TCD combined with ATG significantly increased the risk of EBV reactivation (P < .001). Joost W. J. van Esser et al. Blood 2001;98:972-978 ©2001 by American Society of Hematology

Monitoring EBV load after matched unrelated SCT Monitoring EBV load after matched unrelated SCT.A 16-year-old EBV-seropositive male with a Philadelphia chromosome–positive (Ph+) ALL in first complete remission received a TCD matched unrelated donor graft from an EBV-seropositive donor. Monitoring EBV load after matched unrelated SCT.A 16-year-old EBV-seropositive male with a Philadelphia chromosome–positive (Ph+) ALL in first complete remission received a TCD matched unrelated donor graft from an EBV-seropositive donor. Multiple EBV reactivations were observed; however, no EBV-LPD ensued. Frequent examination of bone marrow for the presence of monoclonal B cells and whole-body CT to detect lymphadenopathy were negative at various time points (*). At day 211, DLI (1.0 × 105 CD3+ T cells/kg) was administered because of molecular relapse of his Ph+ ALL. Currently, the patient is free of disease and well at day 800 after SCT. CyA indicates cyclosporin A. Joost W. J. van Esser et al. Blood 2001;98:972-978 ©2001 by American Society of Hematology

Incidence of EBV reactivation by number of CD34+ cells in the graft Incidence of EBV reactivation by number of CD34+ cells in the graft.The median number of CD34+ cells in the graft was 1.35 × 106/kg. Incidence of EBV reactivation by number of CD34+ cells in the graft.The median number of CD34+ cells in the graft was 1.35 × 106/kg. Patients with grafts containing more than 1.35 × 106/kg were at higher risk (P = .001) of EBV reactivation. Joost W. J. van Esser et al. Blood 2001;98:972-978 ©2001 by American Society of Hematology

Incidence of EBV-LPD.Incidence of EBV-LPD (n = 10) after TCD-allogeneic SCT combined with ATG (n = 24), TCD-SCT without ATG (n = 61), and non–TCD-SCT (n = 65). Incidence of EBV-LPD.Incidence of EBV-LPD (n = 10) after TCD-allogeneic SCT combined with ATG (n = 24), TCD-SCT without ATG (n = 61), and non–TCD-SCT (n = 65). Joost W. J. van Esser et al. Blood 2001;98:972-978 ©2001 by American Society of Hematology