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Infectious Medicine

Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation

Leukemia volume 25, pages 932–938 (2011)Cite this article

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Abstract

This single centre study assessed the incidence, kinetics and predictive factors of Epstein-Barr Virus (EBV) reactivation and EBV-related lymphoproliferative diseases (LPDs) in 175 consecutive patients who received a reduced-intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT). The cumulative incidence of EBV reactivation at 6 months after allo-HSCT defined as an EBV PCR load above 1000 copies of EBV DNA/105 cells was 15%, and none of these patients experienced any sign or symptom of LPD. A total of 17 patients, who had EBV DNA levels exceeding 1000 copies/105 cells on two or more occasions, were pre-emptively treated with rituximab. With a median follow-up of 655 (range, 92–1542) days post allo-HSCT, there was no statistically significant difference in term of outcome between those patients who experienced an EBV reactivation and those who did not. In multivariate analysis, the use of antithymocyte globulin as part of the RIC regimen was the only independent risk factor associated with EBV reactivation (relative risk=4.9; 95% confidence interval, 1.1–21.0; P=0.03). We conclude that patients undergoing RIC allo-HSCT using anti-thymocyte globulin as part of the preparative regimen are at higher risk for EBV reactivation. However, this did not impact on outcome, as quantitative monitoring of EBV viral load by PCR and preemptive rituximab therapy allowed for significantly reducing the risk of EBV-related LPD.

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Acknowledgements

We thank the nursing staff for providing excellent care for our patients. We also thank the ‘Région Pays de Loire’, the ‘Association pour la Recherche sur le Cancer (ARC)’, the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’ and the ‘Association Laurette Fuguain’, for their generous and continuous support for our clinical and basic research work. Our group is supported by several grants from the French national cancer institute (PHRC, INCa). The authors would like to acknowledge the continuous support of the cell banking facility (‘tumurotheque’) of the CHU de Nantes.

Author contributions

Z Peric: collected and assembled and analyzed data, wrote and revised the manuscript; X Cahu: collected data, performed statistical analysis, and helped writing and revising the manuscript; E Brissot, F Malard: collected and assembled data; T Guillaume, J Delaunay, P Chevallier, S Ayari, V Dubruille, S Le Gouill, B Mahe, T Gastinne, N Blin, JL Harousseau, P Moreau, N Milpied: recruited patients, and commented on the manuscript; B Saulquin: collected and assembled data; M Coste-Burel, BM Imbert-Marcille: performed viral monitoring and commented on the manuscript; M Mohty: supervised research, analyzed data, performed statistical analysis, wrote and revised the manuscript; All authors approved submission of the manuscript for publication purposes.

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Author notes

  1. X Cahu

    Present address: 6Current address: Centre Hospitalier et Universitaire (CHU) de Rennes, Service d'Hématologie Clinique, Rennes, France.,

  2. B Saulquin & J-L Harousseau

    Present address: 7Current address: Centre Régional de Lutte contre le Cancer (CRLCC) René Gauducheau, Nantes, France.,

  3. N Milpied

    Present address: 8Current address: Centre Hospitalier et Universitaire (CHU) de Bordeaux, Service d'Hématologie Clinique, Bordeaux, France.,

Authors and Affiliations

  1. Centre Hospitalier et Universitaire (CHU) de Nantes, Service d'Hématologie Clinique, Nantes, France

    Z Peric, X Cahu, P Chevallier, E Brissot, F Malard, T Guillaume, J Delaunay, S Ayari, V Dubruille, S Le Gouill, B Mahe, T Gastinne, N Blin, B Saulquin, J-L Harousseau, P Moreau, N Milpied & M Mohty

  2. Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, Nantes, France

    Z Peric, S Le Gouill, B Saulquin, P Moreau & M Mohty

  3. EA4271, Université de Nantes, IFR26, Nantes, France

    P Chevallier, T Guillaume, M Coste-Burel & B-M Imbert-Marcille

  4. Université de Nantes and INSERM CRNCA UMR 892, Nantes, France

    S Le Gouill, J-L Harousseau, P Moreau & M Mohty

  5. Laboratoire de Virologie, CHU de Nantes, Nantes, France

    M Coste-Burel & B-M Imbert-Marcille

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Correspondence to M Mohty.

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Peric, Z., Cahu, X., Chevallier, P. et al. Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation. Leukemia 25, 932–938 (2011). https://doi.org/10.1038/leu.2011.26

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