Epstein-Barr virus-associated lymphoproliferative diseases (EBV-LPD) after hematopoietic stem cell transplantation or solid-organ transplantation remain a serious and potentially life-threatening complication. In the last decade, outcomes for EBV-LPD have significantly improved. Key to this success was the development of early detection methods, such as serial measurements of EBV-DNA load in the peripheral blood of transplant recipients. Immunotherapeutic interventions for EBV-LPD include reduction of immunosuppression, CD20 monoclonal antibodies (rituximab) as monotherapy or in conjunction with chemotherapy, and adoptive immunotherapy with EBVspecific T cells. Pre-emptive immunotherapeutic interventions can prevent the development of EBV-LPD. As monotherapy, immunotherapy is effective in inducing remissions of EBV-LPD with low-risk features. For high-risk disease, combining immunotherapy with conventional therapies has led to superior outcomes. Current challenges consist of risk stratifying patients so that patients receive the most efficacious therapy without suffering from unwanted side effects.
KeywordsEpstein-Barr virus; lymphoproliferative disease; monoclonal antibody; rituximab; T-cell therapy; transplantation An increased incidence of lymphomas in immunosuppressed transplant recipients was first recognized in 1969 and further studies demonstrated that 90% of these lymphoproliferative diseases (LPDs) were positive for Epstein-Barr virus (EBV) [1,2]. EBV-LPD comprises a heterogeneous group of malignancies, ranging from polyclonal hyperplasias to monoclonal, aggressive non-Hodgkin's lymphomas [3]. The development of EBV-LPD is linked to a deficient EBV-specific cellular immune response. In hematopoietic stem cell transplant (HSCT) recipients, this is caused by high-dose chemotherapy and/or radiation administered as part of the conditioning regimen, T-cell depletion and additional immunosuppression to prevent graft-versus-host disease (GvHD), and in solid-organ transplant (SOT) recipients by immunosuppression administered to prevent graft rejection [4][5][6]. This article reviews the use of immunotherapeutic intervention for the prevention and treatment of EBV-LPD and summarizes potential strategies to improve current approaches.