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Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.

Publication ,  Journal Article
Lindsay, J; Othman, J; Heldman, MR; Slavin, MA
Published in: Curr Opin Infect Dis
December 1, 2021

PURPOSE OF REVIEW: Management of Epstein-Barr virus posttransplant lymphoproliferative disorder (EBV PTLD) is complex, involving risk stratification, prevention and/or preemptive measures involving monitoring EBV DNAemia and balancing treatment options, using a combination of reduction of immune suppression, anti-B cell therapy, and cytotoxic T lymphocytes (CTLs). RECENT FINDINGS: The highest risk factor for the development of EBV PTLD in hematopoietic cell transplant (HCT) remains T cell depletion, with increasing use of antithymocyte globulin (ATG) or alemtuzumab in conditioning. In solid organ transplantation (SOT), the incidence of PTLD is highest among EBV seronegative recipients who are at risk for primary EBV infection following transplant in the first 12 months. Prevention is a critical component of the management of EBV PTLD. Although preemptive therapy remains standard of care, there continues to be heterogenicity and debate over the optimal choice of EBV DNA quantification and the threshold to use. Novel therapies such as donor-derived multipathogen and EBV specific CTLs for the prevention and third party CTLs for the treatment of EBV PTLD are promising, with rapidly expanding evidence, including large scale Phase III trials currently underway. SUMMARY: With an increasing number of risk groups for developing EBV PTLD in HCT and SOT, management strategies using prophylaxis or preemptive therapy remain standard of care, however the use of prophylactic or preemptive EBV specific or multipathogen CTLs show promising results and safety profiles.

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Published In

Curr Opin Infect Dis

DOI

EISSN

1473-6527

Publication Date

December 1, 2021

Volume

34

Issue

6

Start / End Page

635 / 645

Location

United States

Related Subject Headings

  • Organ Transplantation
  • Microbiology
  • Lymphoproliferative Disorders
  • Humans
  • Herpesvirus 4, Human
  • Hematopoietic Stem Cell Transplantation
  • Epstein-Barr Virus Infections
  • 3202 Clinical sciences
  • 1108 Medical Microbiology
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lindsay, J., Othman, J., Heldman, M. R., & Slavin, M. A. (2021). Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes. Curr Opin Infect Dis, 34(6), 635–645. https://doi.org/10.1097/QCO.0000000000000787
Lindsay, Julian, Jad Othman, Madeleine R. Heldman, and Monica A. Slavin. “Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.Curr Opin Infect Dis 34, no. 6 (December 1, 2021): 635–45. https://doi.org/10.1097/QCO.0000000000000787.
Lindsay J, Othman J, Heldman MR, Slavin MA. Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes. Curr Opin Infect Dis. 2021 Dec 1;34(6):635–45.
Lindsay, Julian, et al. “Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.Curr Opin Infect Dis, vol. 34, no. 6, Dec. 2021, pp. 635–45. Pubmed, doi:10.1097/QCO.0000000000000787.
Lindsay J, Othman J, Heldman MR, Slavin MA. Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes. Curr Opin Infect Dis. 2021 Dec 1;34(6):635–645.

Published In

Curr Opin Infect Dis

DOI

EISSN

1473-6527

Publication Date

December 1, 2021

Volume

34

Issue

6

Start / End Page

635 / 645

Location

United States

Related Subject Headings

  • Organ Transplantation
  • Microbiology
  • Lymphoproliferative Disorders
  • Humans
  • Herpesvirus 4, Human
  • Hematopoietic Stem Cell Transplantation
  • Epstein-Barr Virus Infections
  • 3202 Clinical sciences
  • 1108 Medical Microbiology
  • 1103 Clinical Sciences