Strategy of pre-emptive management of Epstein-Barr virus post-transplant lymphoproliferative disorder after stem cell transplantation: results of European transplant centers survey

Abstract

Aim of the studyEpstein-Barr virus-related post-transplant lymphoproliferative disorder (EBV-PTLD) is a serious complication after stem cell transplantation (SCT) and the number of patients at risk is increasing over time. Available data do not reflect general practice of diagnosis and treatment of this complication.Material and methodsIn 2009 a survey on management of the pre-emptive strategy of EBV infection was done and results from 74 European transplant centers were registered and analyzed.ResultsRegular monitoring for EBV after SCT is done by most of the participating centers (73%). In 68% of them the monitoring is performed in all alloSCT patients, while in remaining centers it is done in high-risk patients only. Quantitative EBV-DNA is performed in 97% of centers, mainly in whole blood (78%) and usually repeated once a week (60.9%). The monitoring for EBV reactivation is performed for a period of 3 months (37%) to 6 months (30%) or adjusted to risk factors (20%). Rituximab as a pre-emptive therapy for EBV-PTLD is routinely administered in 80% of responding centers. The number of EBV-DNA copies as an indicator for pre-emptive therapy with rituximab varies between the centers.ConclusionsThe strategy of management of EBV infection exists in most of the responding centers. Different approaches regarding indications for preemptive therapy are seen between centers: rituximab is administered as pre-emptive therapy in most participating transplant centers.

Dynamics of Epstein‐Barr viral load after hematopoietic stem cell transplantation and effect of preemptive rituximab therapy

“…The various levels of BEBVL that triggered rituximab use in our cohort reflect the scarcity of recommendations concerning the ideal threshold. Interestingly, a European‐wide study of 64 HSCT centers showed that this threshold was heterogeneous, from 1000 cp/mL to 10 000, 50 000, or 100 000 cp/mL . Our study did not identify a threshold that was associated with rituximab benefit in terms of long‐term survival, although the better short‐term survival after rituximab in patients with BEBVL ≥1000, 5000, or 10 000 suggests that BEBVL level could be considered as one of several decision factors.…”

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

“…After HSCT, some centers monitor for EBV viremia and reduce immunosuppression or consider rituximab for B-cell depletion pre-emptively; this strategy is recommended by the Sixth European Conference on Infections in Leukemia (ECIL-6), and entails performing weekly quantitative EBV PCR tests from whole blood, plasma or serum from the first through fourth month post-transplant [138]. However, the optimal EBV viremia threshold for which pre-emptive therapy should be instituted is unknown, and leads to significant practice variability [142][143][144]. Suggested EBV viral load cut-offs for rituximab range from 100 to 10,000 copies/mL [140,142,145,146].…”

Rituximab in treatment of post-transplant lymphoproliferative disease after allogeneic stem cell transplantation

“…This preemptive strategy is a common practice in 80% of European transplant centres [14]. The use of 1-2 weekly rituximab doses is usually sufficient to stop the viral replication, although the timing of preemptive therapy is a matter of discussion.…”

“…Regular monitoring of EBV load allows early, preemptive treatment to be started in patients at risk for PTLD development. The EBMT (European Group for Blood and Marrow Transplantation) survey shows that once weekly monitoring of EBV-DNA for 3-6 months after transplant is performed by more than 70% of European transplant centres [14]. Quantitative PCR to measure EBV-DNA load in whole blood is the recommended method in the posttransplant setting [9].…”