Effect of combined T‐ and B‐cell depletion of allogeneic HLA‐mismatched bone marrow graft on the magnitude and kinetics of Epstein–Barr virus load in the peripheral blood of bone marrow transplant recipients

Abstract

Recipients of T-cell-depleted bone marrow (BM) transplants (BMT) frequently develop Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) preceded by a rapid and prominent increase of EBV load in the peripheral blood. The level of this increase positively correlates with the incidence of PTLD. Using a semiquantitative PCR assay we compared the blood levels of EBV-DNA in patients transplanted with either T-cell or T- and B-cell-depleted human leukocyte antigen (HLA)-mismatched BM grafts. Combined T- and B-cell depletion correlated with significantly lower maximal levels of EBV load, which were reached with slower kinetics. These data indicate that B-cell depletion of BM can be used for prophylaxis of PTLD in BM transplant recipients and can affect the long-term balance between EBV and its host.

Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia

“…Ganciclovir can reduce EBV replication, but neither ganciclovir/foscarnet nor cidofovir therapy/prophylaxis have any impact on the development of EBV-PTLD, so antiviral agents are not recommended (EII). In case of high EBV load, B-cell depletion before allo-SCT (CIII) 164 or prophylactic use of rituximab early after allo-SCT (CIII) are optional. Immune globulin for prevention of EBV reactivation or disease is not recommended in patients undergoing SCT (DIII).…”

Management of Epstein-Barr Virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European Conference on Infections in Leukemia (ECIL-6) guidelines

“…B-cell depletion by prophylactic use of rituximab before or shortly after allo-HSCT might reduce the risk of EBV DNA-emia and PTLD (Table 6). 20,23,69,70 In a large retrospective analysis, prophylactic post-transplant rituximab significantly reduced the risk of EBV DNAemia; however, no statistically significant impact on PTLD incidence, treatment-related mortality, and overall survival in comparison to a pre-emptive approach was demonstrable. 69 Low risk of EBV-PTLD was observed also after the use of post-transplant high-dose cyclophosphamide, 23 or sirolimus as GvHD prophylaxis.…”

Reconstitution of lymphocyte subpopulations in children with inherited metabolic storage diseases after haematopoietic cell transplantation

“…We considered our patients to be at an increased risk of developing EBV‐PTLD because of the use of mismatched unrelated donors, TCD of the graft and the use of anti‐thymocyte globulin (ATG). Several reports have shown that selective TCD increases the risk while combined T‐ and B‐cell depletion decreases it, suggesting that B‐cell depletion might be used for prophylaxis (Meijer et al , 2002; Liu et al , 2004). Because of the number of B cells in the infused product, we adopted prophylaxis with anti‐CD20 monoclonal antibody rather than pre‐emptive therapy.…”