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The real‐time polymerase chain reaction‐guided modulation of immunosuppression enables the pre‐emptive management of Epstein–Barr virus reactivation after allogeneic haematopoietic stem cell transplantation
Author(s) -
Cesaro Simone,
Murrone Antonio,
Mengoli Carlo,
Pillon Marta,
Biasolo Maria A.,
Calore Elisabetta,
Tridello Gloria,
Varotto Stefania,
Alaggio Rita,
Zanesco Luigi,
Palù Giorgio,
Messina Chiara
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2004.05287.x
Subject(s) - immunosuppression , viral load , medicine , transplantation , immunology , peripheral blood mononuclear cell , polymerase chain reaction , virus , epstein–barr virus , lymphoproliferative disorders , stem cell , gastroenterology , biology , lymphoma , biochemistry , genetics , gene , in vitro
Summary To assess a real‐time polymerase chain reaction‐based modulation of immunosuppression in patients with an increasing Epstein–Barr virus (EBV) viral load, we studied 79 paediatric allogeneic stem cell transplantations (allo‐SCT) performed between January 1998 and December 2003. EBV reactivation was observed in 42 of 79 patients (53%) after a median time of 45 d from allo‐SCT: 37 (88%) and five (12%) patients had received the graft from an unrelated and a related donor respectively ( P = 0·001). Twenty‐eight patients (67%) had a viral load ≥300 genomic copies ×10 5 peripheral blood mononuclear cells (PBMC) and antithymocyte globulin was the only factor significantly associated with EBV reactivation ( P = 0·001, RR 7·1). Among these 28 patients, immunosuppression was suspended and reduced in 17 and 11 patients respectively. Overall, post‐transplant lymphoproliferative disease was diagnosed in one of 79 patients (1%). The pre‐emptive modulation of immunosuppression in patients with EBV reactivation and a viral load ≥300 genomic copies ×10 5 PBMC did not negatively influence transplant‐related mortality, overall survival or event‐free survival. In conclusion, EBV reactivation is frequent even in ‘low risk’ patients and the pre‐emptive modulation of immunosuppression enables it to be managed safely, with no significant flare in graft‐ versus ‐host disease status.