The load of Epstein-Barr virus (EBV) in peripheral blood mononuclear cells of transplant recipients represents a predictive parameter for posttransplant lymphoproliferative disorders (PTLD). The aim of our work was to develop a rapid and reliable PCR protocol for the quantification of cell-associated EBV DNA in transplant recipients. In contrast to previous studies, a protocol that facilitated quantification independent of photometric nucleic acid analysis was established. We took advantage of the real-time PCR technology which allows for single-tube coamplification of EBV and genomic C-reactive protein (CRP) DNA. EBV copy numbers were normalized by division by the amount of CRP DNA, with the quotient representing the actual amount of amplifiable genomic DNA per reaction. Coamplification of CRP DNA did not result in a diminished detection limit for EBV. By using the protocol without normalization, EBV copy numbers in 4 out of 10 PTLD patients were within the normal range determined with data for 114 transplant recipients that served as controls. After normalization, however, all of the PTLD patients had a higher viral load than the control population, indicating an increased sensitivity of the assay. Moreover, EBV copy numbers obtained for one patient by conventional quantification and suggestive of relapsing PTLD were within normal range after normalization. We conclude that normalization of PCR signals to coamplified genomic DNA allows a more accurate quantification of cell-bound EBV.Epstein-Barr virus (EBV)-induced posttransplant lymphoproliferative disorders (PTLD) are a rare but often fatal complication of immunosuppression after bone marrow and organ transplantation. Clinically, PTLD ranges from an infectious mononucleosis-like syndrome-which might respond to reduction of immunosuppression-to a primary extranodal presentation of the disease with a poor prognosis (17). Early diagnosis of PTLD is still a prerequisite for successful treatment, despite advances in therapy (9, 17). Recent studies have demonstrated a direct relationship between the extent of EBV load in peripheral blood mononuclear cells (PBMC) and the risk of developing PTLD (1,2,11,(20)(21)(22)24). Although PTLD patients usually exhibit uncommonly high levels of EBV DNA, new evidence that an increased viral load alone might not be related to PTLD development has emerged (18). Thus, an accepted level of EBV load predictive of PTLD development has not been established as yet.Conventional PCR-based quantification of viral DNA only allows semiquantitative results, and time-consuming hybridization and blotting steps are necessary after amplification (18,22,26,27). These and other disadvantages of conventional quantification have now been overcome by the real-time TaqMan PCR technology using the ABI Prism 7700 sequence detection system (SDS) (8). This technology has already been applied to the detection and quantification of EBV in plasma and cellular DNA (13,16,19,28). Quantification of cell-associated viruses, however, has remained imprecise, sinc...