Incidence, kinetics, and risk factors of Epstein–Barr virus viremia in pediatric patients after allogeneic stem cell transplantation

Abstract

After allogeneic hematopoietic stem-cell transplantation (allo-HSCT), EBV infections can be potentially dangerous and even life threatening. We evaluated the EBV viremia in 80 consecutive allo-HSCT with quantitative EBV-PCR every 2 weeks during the first 3 months and monthly thereafter until 1 yr after allo-HSCT or until death. We found a significantly more frequent viremia in patients who had in vivo T-cell depletion in which 23 out of 51 (45%) had EBV-PCR positivity. The EBV virus load was also significantly higher in the in vivo T-cell depleted group. Three patients developed clinical symptoms of EBV-PTLD and were treated with monoclonal anti-CD20 antibodies. No EBV- driven mortality was seen in this cohort. In our opinion EBV-PCR monitoring is mandatory after allo-HSCT. Most of the patients with EBV viremia had a good evolution after tapering the immune suppression, so this should be the first-line management of pediatric patients with EBV viremia. Monoclonal anti-CD20 antibodies should be reserved for those patients with early symptoms of EBV-PTLD.

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

“…21 Pooling results from published studies in HSCT recipients suggest that administration of rituximab results in a positive outcome for approximately 90% patients treated pre-emptively, and 65% with EBV-PTLD. 2,3,11,12,19,20,24,27,[51][52][53][54][55][56][57][58][59][60][61][62] Recent data demonstrate that RI, when applied in combination with rituximab, appears to improve the outcome by over 80%. 3 RI used alone as preemptive therapy resulted in a 68% success rate.…”

Risk Factors and Utility of a Risk-Based Algorithm for Monitoring Cytomegalovirus, Epstein-Barr Virus, and Adenovirus Infections in Pediatric Recipients after Allogeneic Hematopoietic Cell Transplantation

“…Ex vivo T cell depletion and T cell–depleting agents such as alemtuzumab or antithymocyte globulin (ATG) are used for the prevention of GVHD and graft rejection but carry an increased risk of viral infection because of the resultant delay in immune reconstitution [16,17]. …”

Investigation of Cytomegalovirus, Epstein-Barr Virus and Adenovirus Infections After Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

“…Gequelin ve arkadaşları 51 allojenik HKHT alıcısında %29.4 EBV enfeksiyonu tespit etmişlerdir [24] . Bordon ve arkadaşları allojenik HKHT yapılan 80 çocuk hastada EBV infeksiyonu insidansını %32 olarak ve en yüksek oranın da %30 ile alıcı/donör pozitif grupta olduğunu tespit etmişlerdir [25] . Kampmann ve arkadaşları allojenik HKHT uygulanan 155 çocuk hastada ADV insidansını %17, mortalitesini de %19 olarak bulmuşlardır [26] .…”

“…Bu çalışmada EBV infeksiyonu insidansı %26 bulunmuş olup literatürde bildirilen Bordon (%32) ve Gequelin'in (%29.4) bulgularına yakın, ancak Gomes (%3) ve Hiwarkar'in (%11) bulduğu oranlardan yüksektir [22][23][24][25] . ADV infeksiyonu insidansı ise %2.1 olup yine Gequelin (%17) ve Hiwarkar'in (%15) saptadığı oranlardan daha düşüktür [22,24] .…”

“…Yine Bordon ve arkadaşları da alıcı/donör EBV seropozitifliği durumunda hastalarda EBV infeksiyonu insidansını daha yüksek bulmuşlardır [25] . Goldstein ve arkadaşları da IVIG kullanan hastalarda CMV infeksiyonu insidansının daha düşük olduğunu gözlemişlerdir [19] .…”