Recent developments in the prevention and treatment of Epstein-Barr virus-associated lymphoproliferative diseases

Epstein-Barr virus (EBV) infection and its relevance in post-transplant lymphoproliferative diseases (PTLDs) is an increasing area of concern. PTLD can differ clinically from a mononucleosis-like syndrome to malignant lymphoma. The incidence varies between < 1 and > 20% depending on different risk factors and the kind of transplant. Despite several treatment regimens, including reduction of immunosuppression, antiviral drugs, adoptive immunotherapy and administration of anti-CD20 monoclonal antibodies, the mortality rate is still high. Novel therapeutic strategies for managing PTLD use pharmacological induction of the viral thymidine kinase gene in tumour cells, the target of antivirals based on nucleoside analogues, followed by treatment with ganciclovir. Further treatment modalities include the development of vaccines and targeting of the latent EBV episomes. Prevention of PTLD by pre-emptive therapy based on molecular monitoring of EBV load will represent the main aim to reduce occurrence. This review examines patents and literature for the treatment of EBV-associated lymphoproliferative diseases.