Preemptive diagnosis and treatment of Epstein-Barr virus-associated post transplant lymphoproliferative disorder after hematopoietic stem cell transplant: an approach in development

TitlePreemptive diagnosis and treatment of Epstein-Barr virus-associated post transplant lymphoproliferative disorder after hematopoietic stem cell transplant: an approach in development
Publication TypeJournal Article
Year of Publication2006
AuthorsWeinstock DM, Ambrossi GG, Brennan C, Kiehn TE, Jakubowski A
JournalBone marrow transplantation
Volume37
Issue6
Pagination539 - 546
Date PublishedMar
ISSN0268-3369; 0268-3369
Accession NumberPMID: 16462755; 1705289 [pii]
KeywordsDNA, Viral / blood, Epstein-Barr Virus Infections / diagnosis, Herpesvirus 4, Human / isolation & purification, Humans, Lymphoproliferative Disorders / diagnosis, Polymerase Chain Reaction, Stem Cell Transplantation / adverse effects
Abstract

Hematopoietic stem cell transplant (HSCT) recipients are at risk for Epstein-Barr virus (EBV)-associated, post transplant lymphoproliferative disorder (PTLD). Studies have suggested that early treatment may improve the outcome of patients with PTLD. Thus, significant attention has been focused on PCR-based approaches for preemptive (i.e., prior to clinical presentation) diagnosis. Reports from several transplant centers have demonstrated that HSCT recipients with PTLD generally have higher concentrations of EBV DNA in the peripheral blood than patients without PTLD. However, the PCR values of patients with PTLD typically span multiple orders of magnitude and overlap significantly with values from patients without PTLD. Thus, questions remain about the sensitivity and predictive value of these assays. Preemptive strategies using rituximab and/or EBV-specific cytotoxic T lymphocytes have been evaluated in patients with elevated EBV viral loads. We review the current literature, discuss our institutional experience and identify several areas of future research that could improve the diagnosis and treatment of this life-threatening disorder in HSCT recipients.

DOI10.1038/sj.bmt.1705289
Alternate JournalBone Marrow Transplant.
Notify Library Reference ID1687