How I treat EBV lymphoproliferation

Epstein-Barr virus (EBV)–associated B-cell lymphoproliferation is a life-threatening complication after hematopoietic stem cell or solid organ transplantation resulting from outgrowth of EBV-infected B cells that would normally be controlled by EBV-cytotoxic T cells. During the past decade, early de...

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Bibliographic Details
Published in:Blood 2009-11, Vol.114 (19), p.4002-4008
Main Author: Heslop, Helen E.
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Antiviral Agents - therapeutic use
B-Lymphocytes - immunology
B-Lymphocytes - virology
Biological and medical sciences
Epstein-Barr Virus Infections - diagnosis
Epstein-Barr Virus Infections - etiology
Epstein-Barr Virus Infections - therapy
Hematologic and hematopoietic diseases
Hematopoietic Stem Cell Transplantation - adverse effects
Herpesvirus 4, Human - immunology
Herpesvirus 4, Human - pathogenicity
How I Treat
Humans
Infectious diseases
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lymphoproliferative Disorders - diagnosis
Lymphoproliferative Disorders - etiology
Lymphoproliferative Disorders - therapy
Medical sciences
Rituximab
T-Lymphocytes, Cytotoxic - immunology
T-Lymphocytes, Cytotoxic - transplantation
Tissue Donors
Transplants - adverse effects
Viral diseases
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Summary:Epstein-Barr virus (EBV)–associated B-cell lymphoproliferation is a life-threatening complication after hematopoietic stem cell or solid organ transplantation resulting from outgrowth of EBV-infected B cells that would normally be controlled by EBV-cytotoxic T cells. During the past decade, early detection strategies, such as serial measurement of EBV-DNA load in peripheral blood samples, have helped to identify high-risk patients and to diagnose early lymphoproliferation. Treatment options include manipulation of the balance between outgrowing EBV-infected B cells and the EBV cytotoxic T lymphocyte response and targeting the B cells with monoclonal antibodies or chemotherapy. Major challenges remain for defining indications for preemptive therapies and integrating novel and conventional therapies.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2009-07-143545