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Volume 12, Number 3, 2007

Management of Epstein-Barr virus reactivation following allogeneic stem cell transplantation

Arjan C. Lankester

Summary:

<b>Background</b> Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation (allo-SCT) that may progress to life-threatening
EBV-lymphoproliferative disease (EBV-LPD).
<b>Aim</b> To present data relevant to incidence, diagnosis and contemporary management
of Epstein-Barr virus (EBV) reactivation in children undergoing allogeneic haematopoietic
stem cell transplantation.
<b>Materials/Methods</b> A review of PubMed references based on evidence-based recommendations and own experience.
<b>Results</b> Epstein-Barr virus (EBV) reactivation is a frequent event (5–20%) following allogeneic stem cell transplantation that may progress to life-threatening EBV-lymphoproliferative disease (EBV-LPD), especially after T-cell depletion in vitro and/or
in vivo. Clinical symptoms are frequently lacking in the early stages of EBV reactivation.
The introduction of real-time polymerase chain reaction (RQ-PCR) several
years ago has provided a powerful tool to monitor EBV reactivation in still
asymptomatic allo-SCT recipients and to predict increased risk of developing EBVLPD.
Recently, evidence has been provided that EBV-DNA load guided preemptive
treatment with B cell depleting CD20 monoclonal antibodies (Rituximab®)
is effective in preventing EBV-LPD in allo-SCT recipients at high risk.
<b>Conclusions</b> We propose that simultaneous and on-line analysis of both EBV-DNA load and T cell recovery will improve the identifi cation of patients at high risk for EBV-LPD.
These patients will probably benefi t most from pre-emptive interventions.

Signature: Rep Pract Oncol Radiother, 2007; 12(3) : 163-165

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http://www.sciencedirect.com/science/journal/15071367/19/2