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. 2024 Oct 25:15:1492367.
doi: 10.3389/fimmu.2024.1492367. eCollection 2024.

Epstein-Barr virus reactivation in pediatric allogeneic stem cell transplant recipients: an 11-year experience on viral load and B lymphocyte monitoring strategy

Giulia Ferrando  1 , Francesca Bagnasco  2 , Filomena Pierri  3 , Sara Pestarino  3 , Gianluca Dell'Orso  3 , Stefano Giardino  3 , Eddi Di Marco  4 , Maria Santaniello  1 , Elio Castagnola  1 , Maura Faraci  3
Affiliations

Epstein-Barr virus reactivation in pediatric allogeneic stem cell transplant recipients: an 11-year experience on viral load and B lymphocyte monitoring strategy

Giulia Ferrando et al. Front Immunol. .

Abstract

Background: Epstein-Barr virus (EBV) reactivation represents a frequent condition after allogeneic hematopoietic stem cell transplantation (allo-HCT) and can cause the development of a severe complication: post-transplant lymphoproliferative disease (PTLD). This retrospective study aims at investigating the incidence of EBV reactivations and analyzing the potential impact of recipient/donor-related transplant-related factors in pediatric patients. The secondary objective was to study the consequences of the approach used at our center regarding the initiation of pre-emptive therapy.

Methods: This study used a retrospective evaluation of patients aged ≤25 years who received an allo-HCT at IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Giannina Gaslini, between 2012 and 2022, with follow-up censored in July 2023. Criteria to start rituximab were as follows: a viral load ≥20,000 copies/105 PBMCs or ≥10,000/105 PBMCs associated with a rise in the proportion of CD 20+ lymphocytes.

Results: Overall, 214 allo-HCTs were performed in 189 patients. A total of 127 (59.3%) procedures were complicated by at least one EBV reactivation, but in only one rituximab was administered. All other reactivations were characterized by viremia below reference ranges and no increase in CD20+ lymphocytes, without clinical consequences. Risk factors for EBV reactivation identified were associated with delayed immune reconstitution.

Conclusion: These results could suggest the effectiveness of the approach used in providing pre-emptive therapy. The strategy adopted differs from that highlighted by other studies and allowed the reduction of the number of children who received rituximab. It has proven effective considering the low incidence rate of PTLD and reduces the risk of rituximab-related adverse events.

Keywords: Epstein-Barr; PTLD; hematopoietic stem cell transplantation; pre-emptive therapy; rituximab; viral infection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The proposed risk stratification and management in pediatric HCT recipients. HCT, hematopoietic cell transplantation; GvHD, Graft versus Host Disease; Haplo, haploidentical related donor; PBMC, peripheral blood mononuclear cell.
See this image and copyright information in PMC

References

    1. Faraci M, Caviglia I, Morreale G, Lanino E, Cuzzubbo D, Giardino S, et al. . Viral-load and B-lymphocyte monitoring of EBV reactivation after allogeneic hemopoietic SCT in children. Bone Marrow Transplant. (2010) 45:1052–5. doi: 10.1038/bmt.2009.302 - DOI - PubMed
    1. Styczynski J, van der Velden W, Fox CP, Engelhard D, de la Camara R, Cordonnier C, et al. . Management of epstein-barr virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European conference on infections in leukemia (ECIL-6) guidelines. Haematologica. (2016) 101:803–11. doi: 10.3324/haematol.2016.144428 - DOI - PMC - PubMed
    1. Chiou FK, Beath SV, Patel M, Gupte GL. Hypogammaglobulinemia and bacterial infections following pediatric post-transplant lymphoproliferative disorder in the rituximab era. Pediatr Transplant. (2019) 23:4. doi: 10.1111/petr.13519 - DOI - PubMed
    1. Biehn SE, Kirk D, Rivera MP, Martinez AE, Khandani AH, Orlowski RZ. Bronchiolitis obliterans with organizing pneumonia after rituximab therapy for non-Hodgkin’s lymphoma. Hematol Oncol. (2006) 24:234–7. doi: 10.1002/hon.v24:4 - DOI - PubMed
    1. Griffin JM, Healy FM, Dahal LN, Floisand Y, Woolley JF. Worked to the bone: antibody-based conditioning as the future of transplant biology. J Hematol Oncol. (2022) 15:65. doi: 10.1186/s13045-022-01284-6 - DOI - PMC - PubMed

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