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Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes
Post-transplant lymphoproliferative disease (PTLD) is a fatal complication of hematopoietic cell transplantation (HCT) associated with the Epstein–Barr virus (EBV). Multiple factors such as transplant type, graft-versus-host disease (GVHD), human leukocyte antigens (HLA) mismatch, patient age, and T...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10671524/ https://www.ncbi.nlm.nih.gov/pubmed/38003218 http://dx.doi.org/10.3390/ijms242216029 |
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author | Papalexandri, Apostolia Gavriilaki, Eleni Vardi, Anna Kotsiou, Nikolaos Demosthenous, Christos Constantinou, Natassa Touloumenidou, Tasoula Zerva, Panagiota Kika, Fotini Iskas, Michalis Batsis, Ioannis Mallouri, Despina Yannaki, Evangelia Anagnostopoulos, Achilles Sakellari, Ioanna |
author_facet | Papalexandri, Apostolia Gavriilaki, Eleni Vardi, Anna Kotsiou, Nikolaos Demosthenous, Christos Constantinou, Natassa Touloumenidou, Tasoula Zerva, Panagiota Kika, Fotini Iskas, Michalis Batsis, Ioannis Mallouri, Despina Yannaki, Evangelia Anagnostopoulos, Achilles Sakellari, Ioanna |
author_sort | Papalexandri, Apostolia |
collection | PubMed |
description | Post-transplant lymphoproliferative disease (PTLD) is a fatal complication of hematopoietic cell transplantation (HCT) associated with the Epstein–Barr virus (EBV). Multiple factors such as transplant type, graft-versus-host disease (GVHD), human leukocyte antigens (HLA) mismatch, patient age, and T-lymphocyte-depleting treatments increase the risk of PTLD. EBV reactivation in hematopoietic cell transplant recipients is monitored through periodic quantitative polymerase chain reaction (Q-PCR) tests. However, substantial uncertainty persists regarding the clinically significant EBV levels for these patients. Guidelines recommend initiating EBV monitoring no later than four weeks post-HCT and conducting it weekly. Pre-emptive therapies, such as the reduction of immunosuppressive therapy and the administration of rituximab to treat EBV viral loads are also suggested. In this study, we investigated the occurrence of EBV-PTLD in 546 HCT recipients, focusing on the clinical manifestations and risk factors associated with the disease. We managed to identify 67,150 viral genomic copies/mL as the cutoff point for predicting PTLD, with 80% sensitivity and specificity. Among our cohort, only 1% of the patients presented PTLD. Anti-thymocyte globulin (ATG) and GVHD were independently associated with lower survival rates and higher treatment-related mortality. According to our findings, prophylactic measures including regular monitoring, pre-emptive therapy, and supportive treatment against infections can be effective in preventing EBV-related complications. This study also recommends conducting EBV monitoring at regular intervals, initiating pre-emptive therapy when viral load increases, and identifying factors that increase the risk of PTLD. Our study stresses the importance of frequent and careful follow-ups of post-transplant complications and early intervention in order to improve survival rates and reduce mortality. |
format | Online Article Text |
id | pubmed-10671524 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106715242023-11-07 Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes Papalexandri, Apostolia Gavriilaki, Eleni Vardi, Anna Kotsiou, Nikolaos Demosthenous, Christos Constantinou, Natassa Touloumenidou, Tasoula Zerva, Panagiota Kika, Fotini Iskas, Michalis Batsis, Ioannis Mallouri, Despina Yannaki, Evangelia Anagnostopoulos, Achilles Sakellari, Ioanna Int J Mol Sci Communication Post-transplant lymphoproliferative disease (PTLD) is a fatal complication of hematopoietic cell transplantation (HCT) associated with the Epstein–Barr virus (EBV). Multiple factors such as transplant type, graft-versus-host disease (GVHD), human leukocyte antigens (HLA) mismatch, patient age, and T-lymphocyte-depleting treatments increase the risk of PTLD. EBV reactivation in hematopoietic cell transplant recipients is monitored through periodic quantitative polymerase chain reaction (Q-PCR) tests. However, substantial uncertainty persists regarding the clinically significant EBV levels for these patients. Guidelines recommend initiating EBV monitoring no later than four weeks post-HCT and conducting it weekly. Pre-emptive therapies, such as the reduction of immunosuppressive therapy and the administration of rituximab to treat EBV viral loads are also suggested. In this study, we investigated the occurrence of EBV-PTLD in 546 HCT recipients, focusing on the clinical manifestations and risk factors associated with the disease. We managed to identify 67,150 viral genomic copies/mL as the cutoff point for predicting PTLD, with 80% sensitivity and specificity. Among our cohort, only 1% of the patients presented PTLD. Anti-thymocyte globulin (ATG) and GVHD were independently associated with lower survival rates and higher treatment-related mortality. According to our findings, prophylactic measures including regular monitoring, pre-emptive therapy, and supportive treatment against infections can be effective in preventing EBV-related complications. This study also recommends conducting EBV monitoring at regular intervals, initiating pre-emptive therapy when viral load increases, and identifying factors that increase the risk of PTLD. Our study stresses the importance of frequent and careful follow-ups of post-transplant complications and early intervention in order to improve survival rates and reduce mortality. MDPI 2023-11-07 /pmc/articles/PMC10671524/ /pubmed/38003218 http://dx.doi.org/10.3390/ijms242216029 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Communication Papalexandri, Apostolia Gavriilaki, Eleni Vardi, Anna Kotsiou, Nikolaos Demosthenous, Christos Constantinou, Natassa Touloumenidou, Tasoula Zerva, Panagiota Kika, Fotini Iskas, Michalis Batsis, Ioannis Mallouri, Despina Yannaki, Evangelia Anagnostopoulos, Achilles Sakellari, Ioanna Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title | Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title_full | Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title_fullStr | Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title_full_unstemmed | Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title_short | Pre-Emptive Use of Rituximab in Epstein–Barr Virus Reactivation: Incidence, Predictive Factors, Monitoring, and Outcomes |
title_sort | pre-emptive use of rituximab in epstein–barr virus reactivation: incidence, predictive factors, monitoring, and outcomes |
topic | Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10671524/ https://www.ncbi.nlm.nih.gov/pubmed/38003218 http://dx.doi.org/10.3390/ijms242216029 |
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