Management of Epstein-Barr virus reactivation following allogeneic stem cell transplantation

Background Epstein-Barr virus (EBV) reactivation is a frequent event (5-20%) following allogeneic stem cell transplantation (allo-SCT) that may progress to life-threatening EBV-lymphoproliferative disease (EBV-LPD). Aim To present data relevant to incidence, diagnosis and contemporary management of Epstein-Barr virus (EBV) reactivation in children undergoing allogeneic haematopoietic stem cell transplantation. Materials/Methods A review of PubMed references based on evidence-based recommendations and own experience Results Epstein-Barr virus (EBV) reactivation is a frequent event (5-20%) following allogeneic stem cell transplantation that may progress to life-threatening EBV-lymphoproliferative disease (EBV-LPD), especially after T-cell depletion in vitro and/or in vivo. Clinical symptoms are frequently lacking in the early stages of EBV reactivation. The introduction of real-time polymerase chain reaction (RQ-PCR) several years ago has provided a powerful tool to monitor EBV reactivation in still asymptomatic allo-SCT recipients and to predict increased risk of developing EBV-LPD. Recently, evidence has been provided that EBV-DNA load guided preemptive treatment with B cell depleting CD20 monoclonal antibodies (Rituximab (R)) is effective in preventing EBV-LPD in allo-SCT recipients at high risk. Conclusions We propose that simultaneous and on-line analysis of both EBV-DNA load and T cell recovery will improve the identification of patients at high risk for EBV-LPD. These patients will probably benefit most from pre-emptive interventions.