Prevention and Treatment for Epstein–Barr Virus Infection and Related Cancers

Abstract

Epstein-Barr virus (EBV) was the first herpes virus described as being oncogenic in humans. EBV infection is implicated in post-transplant lymphoproliferative diseases (PTLD) and several other cancers in non-immunocompromised patients, with more than 200,000 new cases per year. While prevention of PTLD is improving, mainly based on EBV monitoring and preemptive tapering of immunosuppression, early diagnosis remains the best current option for the other malignancies. Significant progress has been achieved in treatment, with decreased mortality and morbidity, but some challenges are still to face, especially for the more aggressive diseases. Possible prevention by EBV vaccination would be a more global approach of this public health problem, but further active research is needed before this goal could be reached.

Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment

“…Three patients (0.9%) developed PTLD out of 323 adult patients who underwent liver transplant and all 3 were cases of late-onset [21]. Overall, as already reported in the literature [2,7,8], the incidence rates of PTLD reported in our review were quite broad (0.5-2.9 in kidney and 0.8-3.6 in liver), probably due to the different sizes of the examined cohorts (Table 1).…”

“…In one cohort of children with liver transplants, valganciclovir was used to treat transplant patients showing detectable EBV-DNA. Data showed that long-term treatment (8 months) achieved undetectable EBV-DNA in 47.6% of patients, 60% of whom maintained response when off therapy [8,81].…”

“…There is no consensus treatment model for the optimal management of PTLD due to its clinico-pathologic heterogeneity. Strategies to prevent EBV-associated PTLD usually aim at partially recovering immune surveillance and involve reduction of immune suppression to allow restoration of specific immunity and control of EBV-infected proliferating cells [8,49]. For EBV-induced PTLD, reduction of immunosuppression appears to be effective in 23-50% of cases [72], although the difference in response seems to be related to the degree of reduction of immunosuppression or to the time of disease onset.…”

“…Early lesions consist of benign polyclonal lymphoproliferations, which mostly regress with reduction of the immunosuppressive regimen. P-PTLD is com- the M-PTLD group, EBV-positive lymphomas arise earlier after transplantation than EBV-negative ones [2,[6][7][8]. Regardless of their histological type, PTLDs can also be defined as early-or late-onset if the diagnosis is made within or after 12 months from transplantation, respectively [2,9].…”

“…Among malignancies occurring in transplanted persons, the incidence of PTLD varies according to several risk factors, such as type of transplant, age of recipient, and duration and type of immunosuppression treatment [6][7][8]. The entire PTLD spectrum includes lymphoproliferative entities varying from reactive hyperplasia to malignant lymphoma.…”