Epstein-Barr virus (EBV) infection in haematopoietic stem cell transplant recipients at risk for Post Transplant Lymph proliferative Disease (PTLD)

Abstract

EBV is associated with a spectrum of clinical presentations in Hematopoietic Stem Cell Transplant (HSCT) recipients, from fever to Post Transplant Lymphoproliferative Disorder (PTLD), which arise from the outgrowth of latently infected B cells in the absence of competent immune surveillance by cytotoxic T cells. PTLDs are extremely heterogeneous, ranging from polyclonal hyperplasia to aggressive, non-Hodgkin's lymphoma. Main risk factors for the development of PTLD are unrelated or HLA-mismatched donors, T-cell depletion, and the use of Antithymocyte Globulin (ATG) or anti-CD3 monoclonal antibodies for the prophylaxis or treatment of graft rejection and/or Graft-Versus-Host Disease (GVHD). Some studies have demonstrated that increasing EBV viral load can predict the development of PTLD and quantitative real time PCR has been recommended in the follow-up PF HSCT at risk for PTLD. However, the published assays vary greatly and the main differences are the target loci in the EBV genome in the PCR, the frequency of blood sampling, the peripheral blood components (total blood, plasma or PBMCs) and cut-off values defining the risk for PTLD. The main objectives of the present study are to implement the EBV real time PCR at the HSCT center of Amaral Carvalho Foundation, compare the EBV viral load in different blood components and evaluate the positive and negative predictive values for the development of PTLD in HSCT recipients with high risk for EBV reactivation. (AU)