Preemptive Management of Epstein-Barr Virus Reactivation After Hematopoietic Stem-Cell Transplantation

• DOI: 10.1097/tp.0b013e31819f1c49
• Publication Date: 2009-05-21T21:08:42Z
• Authors: Imran Ahmad; Nguyen V. Cau; John Kwan; Younes Maaroufi; Nathalie Meuleman; Mickael Aoun; Philippe Lewalle; Philippe Martiat; Françoise Crokaert; Dominique Bron
• Keywords: Adult; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Adolescent; Lymphoma; Polymerase Chain Reaction; Antibodies; Monoclonal -- therapeutic use; Young Adult; Antibodies, Monoclonal, Murine-Derived; 03 medical and health sciences; 0302 clinical medicine; Human -- genetics; Hematopoietic Stem Cell Transplantation -- methods; Humans; Immunologic Factors; Survivors; Human -- physiology; Aged; Aplastic -- therapy; Leukemia; Epstein-Barr Virus Infections -- drug therapy; Lymphoma -- therapy; Herpesvirus 4; Hematopoietic Stem Cell Transplantation; Anemia, Aplastic; Antibodies, Monoclonal; Anemia; DNA; Sciences bio-médicales et agricoles; Middle Aged; Virus Activation -- drug effects; Survival Analysis; 3. Good health; Hematopoietic Stem Cell Transplantation -- mortality; Myelodysplastic Syndromes; DNA, Viral; Leukemia -- therapy; Viral -- genetics; Immunologic Factors -- therapeutic use; Rituximab; Myelodysplastic Syndromes -- surgery

Epstein-Barr virus (EBV) reactivation after hematopoietic stem-cell transplantation can lead to posttransplant lymphoproliferative disease (PTLD), which carries a high mortality rate. Among therapeutic and prophylactic options being developed, B-cell depletion with monoclonal antibodies is encouraging. Because viral load correlated PTLD occurrence, we developed preemptive attitude based on polymerase chain reaction (PCR)-guided rituximab administration.We monitored 115 transplant patients quantitative PCR for EBV DNA performed whole-blood samples. Criteria treatment initiation were single above 40,000 genome copies per milliliter (gCop/mL) or two rising values 10,000 gCop/mL. Weekly infusion at the dose of 375 mg/m was administered until negative results available. We evaluated incidence development.Nineteen (16.5%) met criteria treatment. Incidence same in high-risk standard-risk (12 vs. 7, P=0.38). One patient discontinuation therapy due serious adverse event. No other events noticed. Viral disappeared median three cycles therapy, weekly monitoring allowed prompt intervention. PTLD-related death observed, all-cause treated population 68%.Our PCR-guided rituximab-based approach avoid allogeneic feasible but probably overtreated patients. Prospective trials are strongly needed, they should use uniform techniques consider higher threshold initiation.