Epstein-Barr Virus Viral Load in Crohn’s Disease

Reijasse, Didier; Pendeven, Catherine Le; Cosnes, Jacques; Dehée, Axelle; Gendre, Jean–Pierre; Nicolas, Jean‐Claude; Beaugerie, Laurent

doi:10.1097/00054725-200403000-00004

Cited by 68 publications

(37 citation statements)

References 33 publications

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“…32 Somewhat in contrast, in a French study, EBV viral load did not differ significantly between controls and patients with CD, and was not influenced by CD activity or by immunomodulator therapy, including a history of recent IFX infusion. 27 In the present study, none of the patients with lymphoma were exposed to AZA and EBV status was not assessed.…”

Section: Discussionmentioning

confidence: 82%

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The risk of lymphoma and immunomodulators in patients with inflammatory bowel diseases: Results from a population-based cohort in Eastern Europe

Lakatos¹,

Lovász²,

Dávid³

et al. 2013

Journal of Crohn's and Colitis

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Background and aims: Prior studies suggest a small but significantly increased risk of lymphoma in adults with inflammatory bowel disease (IBD), especially in patients treated with thiopurines. No data was available from Eastern Europe. The aim of this study was to analyze the incidence of lymphomas as related to drug exposure, in a population-based Veszprem province database, which included incident cases diagnosed between January 1, 1977 and December 31, 2008. Methods: Data from 1420 incident patients were analyzed (UC: 914, age at diagnosis: 36.5 years; CD: 506, age at diagnosis: 28.5.5 years). Both in-and outpatient records were collected and comprehensively reviewed. The rate of lymphoma was calculated as patient-years of exposure per medication class, of medications utilized in IBD. A v a i l a b l e o n l i n e a t w w w . s c i e n c e d i r e c t . c o mJournal of Crohn's and Colitis (2013) 7, 385-391 Downloaded from https://academic.oup.com/ecco-jcc/article-abstract/7/5/385/377770 by guest on 07 June 2019Results: Of the 1420 patients, we identified three patients who developed lymphoma (one CLL, two low-grade B-cell NHL including one rectal case), during 19,293 patient-years of follow-up (median follow-up: 13 years). All three patients were male. None had received azathioprine or biologicals. The absolute incidence rate of lymphoma was 1.55 per 10,000 patient-years, with 3 cases observed vs. 2.18 expected, with a standardized incidence ratio (SIR) of 1.37 (95% confidence interval . No cases have been exposed to either azathioprine or biologicals. Conclusions: The overall risk of lymphoma in IBD was not increased; only three cases were seen in this population-based incident cohort over a 30-year period. An association with thiopurine exposure was not found.

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Section: Discussionmentioning

confidence: 82%

“…27 Systemic immunodeficiency caused by the immunosuppression ant combined with local deficiency of EBV-specific immunity may also lead to EBV associated lymphomas. 28 The association is however less clear in non-transplant patients.…”

Section: Discussionmentioning

confidence: 99%

The risk of lymphoma and immunomodulators in patients with inflammatory bowel diseases: Results from a population-based cohort in Eastern Europe

Lakatos¹,

Lovász²,

Dávid³

et al. 2013

Journal of Crohn's and Colitis

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“…Reijasse et al measured EBV viral loads in patients with Crohn's disease and EBV sero-positive controls. There was no difference in viral loads between the two groups irrespective of immunomodulator or biological therapy but a minority of patients did have transient, very high EBV viral loads (Reijasse et al, 2004). It is not clear, whether these peaks in EBV viral load are associated with lymphoma risk but this does appear to be the case in post-transplant patients where EBV viral load can predict this outcome (Stevens et al, 2001).…”

Section: Pathogenesis Of Lymphoma In Ibdmentioning

confidence: 94%

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

Prasad¹

2012

New Advances in the Basic and Clinical Gastroenterology

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“…In IBD patients treated with immunosuppressants, the risk of posttransplant-like lymphoproliferations is constant with time [12], so that late lymphomas are frequent. Second, transient increases in the systemic EBV viral load may be observed during IBD flares, with a subsequent return to normal values when the inflammation is controlled, despite the persistent use of immunosuppressants [13]. This makes the interpretation of increasing values of EBV viral load more complex in IBD patients.…”

Section: Lymphomasmentioning

confidence: 99%

Immunosuppression-Related Lymphomas and Cancers in IBD: How Can They Be Prevented?

Beaugerie

2012

Dig Dis

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Most of the immunosuppressive therapy-associated excess lymphomas in IBD are due to a loss of control of Epstein-Barr virus (EBV) infection. Systemic EBV viral-load monitoring and preemptive treatments are extensively used in the posttransplant setting, but these methods have not yet been evaluated in IBD patients and cannot therefore be recommended in this context. However, the systemic EBV viral load should be measured in cases of unexplained fever, lymphadenopathy or hemophagocytic syndrome, in order to optimize the diagnostics of early EBV-related lymphoproliferations. The risk of hepatosplenic T cell lymphoma can, theoretically, be limited by avoiding prolonged combination therapy with thiopurines and anti-tumor necrosis factor (anti-TNF) beyond 2 years in young males. Young males seronegative for EBV are at risk for fatal forms of primary EBV infection, with postmononucleosis lymphoproliferation. This incidence could be limited by considering avoiding treatment with thiopurines in this subgroup of patients. There is a marked excess risk of nonmelanoma skin cancer in IBD patients currently or previously treated with thiopurines, which justifies lifelong sun protection and dermatological screening in these patients. The level of risk is still unclear for monotherapies with anti-TNF. An excess of human papilloma virus (HPV)-related uterine cervix dysplasia and cancer has been reported in various populations of women with IBD, but the proper role of immunosuppressive therapy remains to be quantified. However, yearly screening for uterine cervix abnormalities is recommended for all female IBD patients, along with HPV vaccination in young girls.

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Epstein-Barr Virus Viral Load in Crohn’s Disease

Cited by 68 publications

References 33 publications

The risk of lymphoma and immunomodulators in patients with inflammatory bowel diseases: Results from a population-based cohort in Eastern Europe

The risk of lymphoma and immunomodulators in patients with inflammatory bowel diseases: Results from a population-based cohort in Eastern Europe

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

Immunosuppression-Related Lymphomas and Cancers in IBD: How Can They Be Prevented?

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