Preemptive diagnosis and treatment of Epstein–Barr virus-associated post transplant lymphoproliferative disorder after hematopoietic stem cell transplant: an approach in development
| Autor: | Ann A. Jakubowski, G G Ambrossi, Cameron Brennan, Timothy E. Kiehn, David M. Weinstock |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Epstein-Barr Virus Infections
Herpesvirus 4 Human medicine.medical_specialty medicine.disease_cause Polymerase Chain Reaction Post-transplant lymphoproliferative disorder Herpesviridae hemic and lymphatic diseases Internal medicine Humans Medicine Transplantation Hematology business.industry Hematopoietic stem cell medicine.disease Epstein–Barr virus Lymphoproliferative Disorders surgical procedures operative medicine.anatomical_structure DNA Viral Immunology Rituximab Viral disease business Viral load Stem Cell Transplantation medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 37:539-546 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1705289 |
| Popis: | Hematopoietic stem cell transplant (HSCT) recipients are at risk for Epstein-Barr virus (EBV)-associated, post transplant lymphoproliferative disorder (PTLD). Studies have suggested that early treatment may improve the outcome of patients with PTLD. Thus, significant attention has been focused on PCR-based approaches for preemptive (i.e., prior to clinical presentation) diagnosis. Reports from several transplant centers have demonstrated that HSCT recipients with PTLD generally have higher concentrations of EBV DNA in the peripheral blood than patients without PTLD. However, the PCR values of patients with PTLD typically span multiple orders of magnitude and overlap significantly with values from patients without PTLD. Thus, questions remain about the sensitivity and predictive value of these assays. Preemptive strategies using rituximab and/or EBV-specific cytotoxic T lymphocytes have been evaluated in patients with elevated EBV viral loads. We review the current literature, discuss our institutional experience and identify several areas of future research that could improve the diagnosis and treatment of this life-threatening disorder in HSCT recipients. |
| Databáze: | OpenAIRE |
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