[EBV quantification in children after allogeneic hematopoietic stem cell transplantation].

Area of Science:

• Hematology
• Virology
• Immunology

Context:

• Allogeneic hematopoietic stem cell transplantation (AHSCT) carries a risk of Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disease (EBV-LPD).
• Previous outcomes for EBV-LPD following AHSCT were associated with significant mortality.
• Predictive factors for EBV reactivation in this vulnerable patient population require investigation.

Purpose:

• To retrospectively analyze EBV viral loads in patients who died from EBV-LPD post-AHSCT.
• To prospectively evaluate EBV reactivation and its predictors in a cohort of pediatric AHSCT recipients.
• To assess the efficacy of quantitative EBV viral load monitoring in preventing EBV-LPD.

Summary:

• Retrospective analysis of four fatal EBV-LPD cases revealed high EBV viral loads preceding death.
• Prospective monitoring of 72 pediatric AHSCT patients identified EBV reactivation in approximately 50% within 100 days.
• Three of four patients with high EBV loads developed EBV-LPD but were successfully treated with anti-CD20 antibody; no deaths occurred during the monitoring period.

Impact:

• Quantitative EBV viral load monitoring with a threshold of 10,000 copies/100,000 genome equivalents proved effective in preventing EBV-LPD deaths.
• This strategy led to zero EBV-related deaths during the study period, a significant improvement over the previous year.
• The study highlights the critical role of regular EBV viral load surveillance in managing AHSCT patients.