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Prospective Epstein–Barr virus‐related post‐transplant lymphoproliferative disorder prevention program in pediatric allogeneic hematopoietic stem cell transplant: virological monitoring and first‐line treatment
Author(s) -
Chiereghin A.,
Prete A.,
Belotti T.,
Gibertoni D.,
Piccirilli G.,
Gabrielli L.,
Pession A.,
Lazzarotto T.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12485
Subject(s) - medicine , post transplant lymphoproliferative disorder , hematopoietic stem cell transplantation , stem cell , hematopoietic stem cell , hematopoietic cell , immunology , epstein–barr virus , transplantation , virus , virology , haematopoiesis , biology , genetics
Background In 28 pediatric allogeneic hematopoietic stem cell transplant (allo‐ HSCT ) recipients, we aimed to evaluate: (i) the impact of routine Epstein–Barr virus ( EBV ) DNA monitoring on the development of EBV ‐related post‐transplant lymphoproliferative disorder ( EBV ‐ PTLD ); (ii) the incidence of EBV infection and the potential risk factors; and (iii) the suitability of whole blood ( WB ) as clinical specimen to monitor the risk of patients to develop EBV ‐ PTLD . Methods Quantitative real‐time polymerase chain reaction assay was performed on WB samples for all patients. EBV DNA quantification also in peripheral blood mononuclear cells ( PBMC s) samples was adopted for the patients at higher risk of developing EBV ‐ PTLD (≥10,000 copies/mL WB ). Results High EBV DNA emia levels were observed in 37.5% of the actively infected recipients (57.1%). Severe aplastic anemia, matched‐unrelated donor transplant, the reduced‐intensity conditioning regimen and, to a lesser extent, the in vivo T‐cell depletion with anti‐thymocyte immunoglobulin were associated with high viral load. A significant correlation between EBV DNA levels in WB and PBMC samples was obtained ( r = 0.755, P < 0.001). A similar kinetics of EBV DNA in the 2 blood compartments was observed. Clinically, both specimen types appeared to be equally informative to assess the risk of patients to develop PTLD . On the basis of EBV DNA emia levels, in 3 patients (10.7%) immunosuppressive therapy was reduced and 1 patient (3.5%) received early treatment for probable EBV disease. No patients developed EBV ‐ PTLD . Conclusion WB proved to be a suitable clinical specimen to monitor EBV DNA load after allo‐ HSCT for the management of EBV infection and PTLD prevention.