[Monitoring of early Epstein-Barr virus reactivation and preemptive therapy after allogeneic hematopoietic stem cell transplantation].

Abstract

OBJECTIVE:

To investigate early Epstein-Barr virus (EBV) reactivation and the outcome of preemptive therapy after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS:

From January 2007 to January 2009, totally 277 patients after allo-HSCT were studied (haploidentical 116, unrelated 75, matched sibling 86). Conditioning regimens were mainly busulfan (BU) + cyclophosphamide (CY)/fludarabine (Flu) or total body irradiation (TBI) + CY/Flu. Antihuman thymocyte globulin (ATG) was added in haploidentical and unrelated transplants. Plasma EBV DNA was monitored once to twice weekly in the first 3 months after allo-HSCT with real time quantitative polymerase chain reaction (RQ-PCR). EBV viremia was diagnosed when EBV DNA was more than 5 × 10(2) copies/ml but without symptoms. Acyclovir (10 mg/kg, intravenous drip, 8 h) was used for preemptive therapy and immuno-suppressants were decreased if possible.

RESULTS:

Totally 33 patients (11.9%) developed EBV viremia with a median time at day 44 (day 19 to day 84). The incidences of EBV viremia in the transplants from matched sibling, haploidentical, unrelated donors were 0, 15.5%, 20.0%, respectively. There was no significant difference between haploidentical and unrelated transplants (P = 0.09), but much less EBV viremia was seen in matched sibling transplant (P = 0.001). Twenty of 33 patients (60.6%) had complete response to preemptive therapy. The median time to reach EBV DNA negative in plasma was 11 (4 - 56) d. The median duration of preemptive therapy was 21 (14 - 60) d. Both univariate and multivariate analysis indicated that haploidentical and unrelated transplants, acute graft versus host disease (GVHD) were the risk factors for EBV viremia. Two-year overall survival in the patients with EBV viremia was significantly lower than that without EBV viremia (54.2% vs 72.1%, P = 0.006).

CONCLUSIONS:

Our large clinical study has demonstrated that preemptive therapy with acyclovir that is guided by EBV viremia is effective in majority of the patients with high-risk for EBV reactivation after allo-HSCT, which may further decrease the risk for developing life-threatening EBV disease or post-transplantation lymphoproliferative disorder. Haploidentical and unrelated transplants, acute GVHD are the risk factors for EBV viremia which has negative impact on survival.

• Authors: Yue Lu, Tong Wu, Xing-yu Cao, Jing-bo Wang, Yuan Sun, Yan-li Zhao, Wan-ming DA, Shu-quan Ji, Chun-rong Tong, Dao-pei Lu
• Journal: Zhonghua nei ke za zhi (Zhonghua Nei Ke Za Zhi) Vol. 50 Issue 5 Pg. 383-7 (May 2011) ISSN: 0578-1426 [Print] China
• PMID: 21624219 (Publication Type: English Abstract, Journal Article)

Chemical References

• DNA, Viral
• Acyclovir

Topics

• Acyclovir (therapeutic use)
• Adolescent
• Adult
• Child
• Child, Preschool
• DNA, Viral (blood)
• Epstein-Barr Virus Infections (etiology, prevention & control, therapy)
• Female
• Hematopoietic Stem Cell Transplantation
• Herpesvirus 4, Human (genetics, physiology)
• Humans
• Male
• Middle Aged
• Postoperative Period
• Transplantation, Homologous
• Viral Load
• Viremia (etiology, prevention & control, therapy)
• Virus Activation
• Young Adult