TY - JOUR
T1 - Epstein-Barr virus-associated lymphoproliferative disease after allogeneic haematopoietic stem cell transplantation: molecular monitoring and early treatment of high-risk patients
AU - Meijer, Ellen
AU - Cornelissen, Jan
PY - 2008
Y1 - 2008
N2 - Purpose of review Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD) is a rare but serious complication in recipients of allogeneic stem cell transplants. An overview is given of the incidence, monitoring and (early) treatment of EBV-LPD. Recent findings The most important risk factor for EBV-LPD is the use of in-vivo T-cell depletion with antithymocyteglobulin. In addition, alternative donor stem cell transplantation is associated with an increased risk for EBV-LPD. Monitoring of EBV DNA in high-risk patients and subsequent early treatment is very successful, resulting in a low EBV-associated mortality. The monitoring of EBV-specific cytotoxic T lymphocytes might further increase the positive predictive value of EBV DNAemia for EBV-LPD. Once overt EBV-LPD has been diagnosed, rituximab treatment is indicated, guided by monitoring of EBV DNA. The infusion of donor lymphocytes is highly effective, but may be complicated by graft-versus-host disease. Therefore, the infusion of T cells, which have been depleted of alloreactive cells, is currently receiving attention. Summary EBV DNA levels should be monitored in patients with high-risk features. Early treatment may be instituted at predefined DNA levels (preemptive approach) or at the earliest signs of LPD (prompt approach). Stepwise treatment guided by EBV DNA, including interruption of immunosuppression, rituximab, and adoptive T-cell immunotherapy may all add to the low mortality currently associated with LPD following allogeneic stem cell transplantation.
AB - Purpose of review Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD) is a rare but serious complication in recipients of allogeneic stem cell transplants. An overview is given of the incidence, monitoring and (early) treatment of EBV-LPD. Recent findings The most important risk factor for EBV-LPD is the use of in-vivo T-cell depletion with antithymocyteglobulin. In addition, alternative donor stem cell transplantation is associated with an increased risk for EBV-LPD. Monitoring of EBV DNA in high-risk patients and subsequent early treatment is very successful, resulting in a low EBV-associated mortality. The monitoring of EBV-specific cytotoxic T lymphocytes might further increase the positive predictive value of EBV DNAemia for EBV-LPD. Once overt EBV-LPD has been diagnosed, rituximab treatment is indicated, guided by monitoring of EBV DNA. The infusion of donor lymphocytes is highly effective, but may be complicated by graft-versus-host disease. Therefore, the infusion of T cells, which have been depleted of alloreactive cells, is currently receiving attention. Summary EBV DNA levels should be monitored in patients with high-risk features. Early treatment may be instituted at predefined DNA levels (preemptive approach) or at the earliest signs of LPD (prompt approach). Stepwise treatment guided by EBV DNA, including interruption of immunosuppression, rituximab, and adoptive T-cell immunotherapy may all add to the low mortality currently associated with LPD following allogeneic stem cell transplantation.
U2 - 10.1097/MOH.0b013e328311f438
DO - 10.1097/MOH.0b013e328311f438
M3 - Article
C2 - 18832928
SN - 1065-6251
VL - 15
SP - 576
EP - 585
JO - Current Opinion in Hematology
JF - Current Opinion in Hematology
IS - 6
ER -