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Molecular monitoring and stepwise preemptive therapy for Epstein–Barr virus viremia after allogeneic stem cell transplantation
Author(s) -
Liu Qifa,
Xuan Li,
Liu Hui,
Huang Fen,
Zhou Hongsheng,
Fan Zhiping,
Zhao Ke,
Wu Meiqing,
Xu Lanping,
Zhai Xiao,
Zhang Fuhua,
Liu Can,
Sun Jing,
Huang Xiaojun
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23452
Subject(s) - viremia , rituximab , medicine , immunology , transplantation , viral load , cumulative incidence , hematopoietic stem cell transplantation , gastroenterology , virus , lymphoma
The optimal preemptive therapy for Epstein–Barr virus (EBV)‐associated diseases remains under discussion. We developed a stepwise preemptive therapy (antiviral agents and reduction of immunosuppressants [RI] followed by rituximab) for EBV viremia, based on duration of EBV viremia and changes of viral loads. The blood EBV‐DNA loads were regularly monitored by quantitative real‐time polymerase chain reaction in 251 recipients undergoing allogeneic stem cell transplantation. The 3‐year cumulative incidence of EBV viremia and EBV‐associated diseases were 31.1% ± 3.1% and 15.6% ± 2.5%, which rose steeply with greater numbers of major risk factors. Of the 64 patients undergoing first‐step preemption, 24 achieved complete response (CR) and 40 showed no response, including 25 progressing to EBV‐associated diseases. The effective rates of antiviral agents and RI plus antiviral agents were 2/16 and 22/48 ( P = 0.017). Fourteen achieved CR and one progressed to lymphoproliferative disease in the 15 patients undergoing rituximab preemption. Of the 26 patients progressing to EBV‐associated diseases during preemptive therapy, 20 obtained CR in the 23 cases with rituximab‐based treatments. The preemptive efficacy of RI plus antiviral agents was correlated with the numbers of major risk factors ( r s = −0.298; P = 0.04). B‐cell reconstitution was significantly delayed for at least 6 months in patients with rituximab preemption. The risk of herpesvirus infection was similar in patients who showed effective progress to first‐step and rituximab preemption ( P = 0.094). RI plus antiviral agents could be given priority to low‐risk patients, whereas more frequent monitoring of blood EBV‐DNA and earlier preemptive rituximab should be advocated in high‐risk patients. Am. J. Hematol. 88:550–555, 2013. © 2013 Wiley Periodicals, Inc.