Naslov
The significance of monitoring and the treatment of EBV in patients after the allogeneic stem cell transplantation

Autori
Gredelj Šimec, Njetočka ; Radić Krišto, Delfa ; Milunović, Vibor ; Mandac Rogulj, Inga ; Planinc-Peraica, Ana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Abstract Book / - , 2012

Skup
3rd Souteast European Conference on Chemotherapy and Infection

Mjesto i datum
Dubrovnik, Hrvatska, 08.11.2012. - 11.11.2012

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Nije recenziran

Ključne riječi
EBV infections; allogeneic stem cell transplantation; monitoring

Sažetak
Epstein- Barr virus (EBV) reactivation following allogeneic hematopoietic stem cell transplantation (alloHSCT) is a common complication, potentially leading to development of posttransplant lymphoproliferative disorder (PTLD). EBV reactivation is caused by the lack of EBV-specific cell immunity. PTLD patophysiologic mechanism includes B-lymphocyte proliferation associated with a latent EBV type 3 infection. Affecting T-cell-mediated immunity, including T-cell depletion, with the use of antithymocyte globulin (ATG) or other factors including older age, unrelated alloHSCT or an HLA mismatched graft can contribute to risk of EBV reactivation and PTLD occurrence. PTLD is a heterogenic group of lymphoproliferative disorders varying from reactive polymorphic hyperplasia to aggressive lymphomas. It often occurs in the first sixth months after alloHSCT and manifests with constitutional symptoms and generalized lymphadenopathy. PTLD may also involve extranodal lymphatic tissues (Waldeyer’s ring, lymphatic tissue associated with the gastrointestinal tract, liver and CNS). The course of the disorder is usually indolent, but it may manifest as an aggresive entity. Due to its potentially lethal outcome, it is recommended to perform PCR tests weekly during the first hundred days of follow up after alloHSCT. In the case of EBV viremia (defined as EBV copies greater than 1000) preemptive therapy consists of decreasing the dose of the immunosuppressant and use of rituximab 375 mg/m2 weekly (maximum 4 doses) or until the EBV PCR test is negative. In the follow-up of 11 patients in our centre, EBV viremia was detected in 6 cases. Median of occurence was 45 days. Incidence of EBV viremia was higher in patients with reduced-intensity consolidation involving ATG (4/5) unlike patients consolidated with the standard protocol. All patients with EBV reactivation received two doses of rituximab until the PCR test was negative. No further reactivations were observed. PTLD was verified in two cases. Our results are comparable with the results of similar studies.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA