A Randomized Trial of Ganciclovir versus Ganciclovir Plus Immune Globulin for Prophylaxis Against Epstein-Barr Virus Related Posttransplant Lymphoproliferative Disorder

Humar, Atul; Hébert, Diane; Davies, H. Dele; Humar, Abhinav; Stephens, Derek; O’Doherty, B.; Allen, Upton

doi:10.1097/01.tp.0000202724.07714.a2

Cited by 88 publications

(65 citation statements)

References 26 publications

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“…This is called preemptive therapy. Whereas antiherpesvirus drugs clearly reduce the incidence and severity of posttransplant CMV disease (89,105), their role in the management of posttransplant EBV disease has not been established (98,186).…”

Section: Antiviral Prophylaxismentioning

confidence: 99%

Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

2011

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SUMMARY Epstein-Barr virus (EBV) is a gammaherpesvirus that infects a large fraction of the human population. Primary infection is often asymptomatic but results in lifelong infection, which is kept in check by the host immune system. In some cases, primary infection can result in infectious mononucleosis. Furthermore, when host-virus balance is not achieved, the virus can drive potentially lethal lymphoproliferation and lymphomagenesis. In this review, we describe the biology of EBV and the host immune response. We review the diagnosis of EBV infection and discuss the characteristics and pathogenesis of infectious mononucleosis. These topics are approached in the context of developing therapeutic and preventative strategies.

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Section: Antiviral Prophylaxismentioning

confidence: 99%

Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

2011

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“…Evidence of EBV infection by this method is then followed by one or more of the following: reduction of immunosuppression, antiviral therapy, IVIG, monoclonal antibody therapy directed toward Preventing PTLD in EBV Mismatch Transplants infected B lymphocytes (e.g. rituximab) or infusion of EBVspecific cytotoxic T lymphocytes, all in an effort to prevent PTLD (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…Chemoprophylaxis relies on antiviral therapies such as ganciclovir, valganciclovir or other active antiherpesvirus therapeutics such as acyclovir, but do not necessarily prevent acquisition of infection (4). Passive immunization requires administering intravenous immunoglobulin (IVIG).…”

Section: Introductionmentioning

confidence: 99%

Monitoring Infection with Epstein–Barr Virus among Seromismatch Adult Renal Transplant Recipients

Martin

Dodson

Wheeler

et al. 2011

American Journal of Transplantation

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Patients who undergo Epstein-Barr virus (EBV) seromismatch (D+/R−) transplants have a higher risk for the development of post-transplant lymphoproliferative disorder (PTLD). Adult renal transplant recipients at a single institution were prospectively monitored for EBV during the first year post-transplant. Over a 2-year period, 34 patients (7.78%) were identified as being EBV D+/R− recipients. Patients who developed symptoms or had persistent viremia were pre-emptively administered rituximab. Six recipients were discharged without monitoring on the protocol. Of those six, three (50%) developed PTLD and all three lost their grafts. Twenty (60.6%) of the 34 recipients developed viremia during the first year post-transplant. Of the recipients who became viremic, six (30%) received rituximab. None of the six who received rituximab-developed PTLD. We found that recipients who were not monitored on the protocol were more likely to have PTLD and graft loss compared to those who were (p = 0.008). Post-transplant monitoring of adults who undergo EBV D+/R− kidney transplants for viremia and symptoms associated with EBV infection may prompt intervention which reduces the incidence of PTLD within the first year. Use of rituximab in preventing PTLD among patients with primary EBV infection requires further prospective study to determine its overall safety and efficacy.

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“…46 The use of prophylaxis against EBV infection in EBV-naïve patients has not been shown to be effective in preventing EBV-PTLD in studies to date. 47,48 A strategy of decreasing immune suppression with and without the use of antiviral therapy at the time of EBV infection may be effective in reducing the incidence of EBV-PTLD. 49,50 The prophylactic …”

Section: Post-transplant Lymphoproliferative Disordermentioning

confidence: 99%

Malignancy Following Solid Organ and Hematopoietic Stem Cell Transplantation

Punnett¹

2009

Oncology &Amp; Hematology Review (US)

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There is a growing appreciation of the increased risk for malignancy following solid organ and hematopoietic stem cell transplantation as the survival of these patient populations increases overall. The risk for malignancy is related to a complex interaction of type, degree, and duration of immunosuppression, viral status, and recipient age. Most of the malignancies documented are common in the general population but occur with increasing incidence and have significant implications for post-transplant surveillance. Post-transplant lymphoproliferative disorder is specific to the transplant population and remains a treatment challenge. The development of novel immunosuppressive agents, the use of individualized immunosuppressive regimens, and collaborative therapeutic trials are necessary to advance clinical care for these patients. This article will review the current issues around malignancy in the post-transplant patient population.

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A Randomized Trial of Ganciclovir versus Ganciclovir Plus Immune Globulin for Prophylaxis Against Epstein-Barr Virus Related Posttransplant Lymphoproliferative Disorder

Abstract: No significant difference in EBV viral load suppression was observed when ganciclovir was compared with ganciclovir and IG in high-risk EBV D+/R- patients.

Cited by 88 publications

References 26 publications

Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

Monitoring Infection with Epstein–Barr Virus among Seromismatch Adult Renal Transplant Recipients

Malignancy Following Solid Organ and Hematopoietic Stem Cell Transplantation

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