Clinical risks analysis of EBV infection in patients with allogeneic hematopoietic stem cell transplantation.
- Author:
Xiebing BAO
1
;
Qian ZHU
;
Huiying QIU
1
;
Feng CHEN
;
Shengli XUE
;
Xiao MA
;
Aining SUN
;
Depei WU
Author Information
- Publication Type:Journal Article
- MeSH: Adolescent; Adult; Antilymphocyte Serum; therapeutic use; Child; Child, Preschool; Epstein-Barr Virus Infections; complications; Female; Hematopoietic Stem Cell Transplantation; Herpesvirus 4, Human; Humans; Incidence; Lymphoproliferative Disorders; complications; virology; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Rituximab; therapeutic use; Transplantation, Homologous; Viral Load; Virus Activation; Young Adult
- From: Chinese Journal of Hematology 2016;37(2):138-143
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo analyze the prevalence of Epstein Barr Virus (EBV) infection in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
METHODSThe occurrence of EBV viremia, EBV disease and post-transplant lymphoproliferative disease (PTLD) were retrospectively analyzed in 736 patients received allo-HSCT in single-center from 1st January 2012 through July 31th, 2014.
RESULTSOf 736 patients (302 male and 434 females) with a median age of 31 (2 to 62) years old, EBV infection occurred in 181 patients, the total incidence of EBV infection was 27.6%, with a median time of 57 (16 to 829) days. The cumulative incidences of probable EBV disease and PTLD were 7.2% (13/181) and 2.8% (5/181). Viral load higher than 1.0×10(4) copies/ml occurs in 130 patients, of which 67 patients received rituximab as pre-empty prophylaxis and significantly reduced the incidences of probable EBV disease and PTLD (6.0% vs 22.2%, P=0.009). The mortality was 27.6% in all patients with EBV infection: 24.5% in EBV viremia, 53.8% in probable EBV disease, and 60.6% in PTLD. By univariate and multivariate analysis, the use of anti-thymocyte globulin (ATG), HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The time of first EBV reactivation was closely related with cGVHD(OR=0.620, 95%CI 0.453-0.849, P=0.003) and bone marrow or cord blood (OR=1.156, 95%CI 1.022-2.250, P=0.039) as source of stem cells for transplantation.
CONCLUSIONEBV reactivation is a common complication in patients with allo-HSCT, especially high mortality in PTLD and probable EBV disease. The use of ATG, HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The usage of rituximab as pre-empty prophylaxis may reduce the incidences of probable EBV disease and PTLD.
