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

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 reactivati...

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Bibliographic Details
Published in:British journal of haematology 2005-01, Vol.128 (2), p.224-233
Main Authors: 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
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Child
Child, Preschool
DNA, Viral - analysis
Epstein-Barr virus
Female
haematopoietic stem cell transplantation
Hematologic and hematopoietic diseases
Hematology
Hematopoietic Stem Cell Transplantation
Herpesvirus 4, Human - physiology
Humans
Immunosuppression - methods
Infant
Lymphoproliferative Disorders - therapy
Lymphoproliferative Disorders - virology
Male
Medical sciences
paediatric malignancies
Postoperative Period
post‐transplant lymphoproliferative diseases
real‐time polymerase chain reaction
Reverse Transcriptase Polymerase Chain Reaction
Transplantation, Homologous
Viral Load
Virus Activation
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Summary: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 ×105 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 ×105 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.
ISSN:0007-1048
1365-2141
DOI:10.1111/j.1365-2141.2004.05287.x