Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell--depleted SCT

J W van Esser, B van der Holt, E Meijer, H G Niesters, R Trenschel, S F Thijsen, A M van Loon, F Frassoni, A Bacigalupo, U W Schaefer, A D Osterhaus, J W Gratama, B Löwenberg, L F Verdonck, J J Cornelissen

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    Reactivation of the Epstein-Barr virus (EBV) after allogeneic stem cell transplantation (allo-SCT) may evoke a protective cellular immune response or may be complicated by the development of EBV-lymphoproliferative disease (EBV-LPD). So far, very little is known about the incidence, recurrence, and sequelae of EBV reactivation following allo-SCT. EBV reactivation was retrospectively monitored in 85 EBV-seropositive recipients of a T-cell--depleted (TCD) allo-SCT and 65 EBV-seropositive recipients of an unmanipulated allo-SCT. Viral reactivation (more than 50 EBV genome equivalents [gEq]/mL) was monitored frequently by quantitative real-time plasma polymerase chain reaction until day 180 after SCT. Probabilities of developing viral reactivation were high after both unmanipulated and TCD-allogeneic SCT (31% +/- 6% versus 65% +/- 7%, respectively). A high CD34(+) cell number of the graft appeared as a novel significant predictor (P =.001) for EBV reactivation. Recurrent reactivation was observed more frequently in recipients of a TCD graft, and EBV-LPD occurred only after TCD-SCT. High-risk status, TCD, and use of antithymocyte globulin were predictive for developing EBV-LPD. Plasma EBV DNA quantitatively predicted EBV-LPD. The positive and negative predictive values of a viral load of 1000 gEq/mL were, respectively, 39% and 100% after TCD. Treatment-related mortality did not differ significantly between TCD and non-TCD transplants, but the incidence of chronic graft-versus-host disease was significantly less in TCD patients. It is concluded that EBV reactivation occurs frequently after TCD and unmanipulated allo-SCT, especially in recipients of grafts with high CD34(+) cell counts. EBV-LPD, however, occurred only after TCD, and EBV load quantitatively predicted EBV-LPD in recipients of a TCD graft. (Blood. 2001;98:972-978)

    Original languageEnglish
    Pages (from-to)972-8
    Number of pages7
    Issue number4
    Publication statusPublished - 15-Aug-2001


    • Adolescent
    • Adult
    • Analysis of Variance
    • Cohort Studies
    • DNA, Viral
    • Graft vs Host Disease
    • Hematopoietic Stem Cell Transplantation
    • Herpesvirus 4, Human
    • Humans
    • Incidence
    • Longitudinal Studies
    • Lymphocyte Depletion
    • Lymphoproliferative Disorders
    • Middle Aged
    • Risk Factors
    • T-Lymphocytes
    • Transplantation, Homologous
    • Treatment Outcome
    • Viral Load
    • Virus Activation

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