Journal
AMERICAN JOURNAL OF HEMATOLOGY
Volume 88, Issue 7, Pages 550-555Publisher
WILEY
DOI: 10.1002/ajh.23452
Keywords
-
Categories
Funding
- National High Technology Research and Development Program of China (863 Program) [2011AA020105]
- National Public Health Grand Research Foundation [201202017]
- National Natural Science Foundation of China [81000231, 81270647, 81200388, 30971300]
- Science and Technology Project of Guangdong Province of China [2009A030200007, 2012B031800403]
- Medical Scientific Research Foundation of Guangdong Province [A2010010]
- Guangdong Natural Science Foundation [10451008004004158]
Ask authors/readers for more resources
The optimal preemptive therapy for Epstein-Barr virus (EBV)-associated diseases remains under discussion. We developed a stepwise preemptive therapy (antiviral agents and reduction of immunosuppressants [RI] followed by rituximab) for EBV viremia, based on duration of EBV viremia and changes of viral loads. The blood EBV-DNA loads were regularly monitored by quantitative real-time polymerase chain reaction in 251 recipients undergoing allogeneic stem cell transplantation. The 3-year cumulative incidence of EBV viremia and EBV-associated diseases were 31.1%+/- 3.1% and 15.6%+/- 2.5%, which rose steeply with greater numbers of major risk factors. Of the 64 patients undergoing first-step preemption, 24 achieved complete response (CR) and 40 showed no response, including 25 progressing to EBV-associated diseases. The effective rates of antiviral agents and RI plus antiviral agents were 2/16 and 22/48 (P=0.017). Fourteen achieved CR and one progressed to lymphoproliferative disease in the 15 patients undergoing rituximab preemption. Of the 26 patients progressing to EBV-associated diseases during preemptive therapy, 20 obtained CR in the 23 cases with rituximab-based treatments. The preemptive efficacy of RI plus antiviral agents was correlated with the numbers of major risk factors (rs=-0.298; P=0.04). B-cell reconstitution was significantly delayed for at least 6 months in patients with rituximab preemption. The risk of herpesvirus infection was similar in patients who showed effective progress to first-step and rituximab preemption (P=0.094). RI plus antiviral agents could be given priority to low-risk patients, whereas more frequent monitoring of blood EBV-DNA and earlier preemptive rituximab should be advocated in high-risk patients. Am. J. Hematol. 88:550-555, 2013. (c) 2013 Wiley Periodicals, Inc.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available