EPSTEIN-BARR VIRUS RELATED LYMPHOPROLIFERATIONS AFTER STEM CELL TRANSPLANTATION

Abstract

<p class="MsoNormal" style="text-align: justify; margin: 0cm 0cm 0pt;"><strong><span style="mso-ansi-language: EN-GB;" lang="EN-GB"><span style="font-family: Times New Roman; font-size: small;">Epstein-Barr virus related lymphoproliferative<span style="mso-spacerun: yes;"> </span>disorders are a rare but potentially fatal complication of allogeneic stem cell transplantation with an incidence of 1-3% and<span style="mso-spacerun: yes;"> </span>occurring within 6 months after transplantation.<span style="mso-spacerun: yes;"> </span>The most relevant risk factors include the use of in vivo T-cell depletion with antithymocyte globulin, HLA disparities between donor and recipient, donor type,<span style="mso-spacerun: yes;"> </span>splenectomy etc. The higher the numbers of risk factors the higher the risk of developing Epstein-Barr virus related lymphoproliferative<span style="mso-spacerun: yes;"> </span>disorders. Monitoring EBV viremia after transplantation is of value and it should be applied to high risk patients since it allows pre-emptive therapy initiation<span style="mso-spacerun: yes;"> </span>at specified threshold values<span style="mso-spacerun: yes;"> </span>and early treatment. This strategy<span style="mso-spacerun: yes;"> </span>might reduce mortality which was >80% prior to the implementation of anti-EBV therapy . Treatment of EBV-LPD after allogeneic SCT may consist of anti-B-cell therapy (rituximab), adoptive T-cell immunotherapy or both.</span><a name="12"></a><a name="13"></a><span style="font-size: small;"><span style="font-family: Times New Roman;"> Rituximab treatment should be considered the first treatment option, preferably guided by intensive monitoring of EBV DNA while reduction of immunosuppression should be carefully evaluated for the risk of graft versus host disease.</span></span></span></strong></p>

Keywords

• EBV, Hematopopietic Stem Cell Transplantation, Lymphoma