Prompt versus preemptive intervention for EBV lymphoproliferative disease

Hans Joachim Wagner; Yee Chung Cheng; M. Helen Huls; Adrian P. Gee; Ingrid Kuehnle; Robert A. Krance; Malcolm K. Brenner; Cliona M. Rooney; Helen E. Heslop

doi:10.1182/blood-2003-12-4287

Prompt versus preemptive intervention for EBV lymphoproliferative disease

Hans Joachim Wagner, Yee Chung Cheng, M. Helen Huls, Adrian P. Gee, Ingrid Kuehnle, Robert A. Krance, Malcolm K. Brenner, Cliona M. Rooney, Helen E. Heslop

Research output: Contribution to journal › Article › peer-review

194 Scopus citations

Abstract

Posttransplantation lymphoproliferative disorders (PTLDs) caused by uncontrolled expansion of Epstein-Barr virus (EBV)-infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by an increase in EBV DNA in peripheral blood mononuclear cells. We used real-time quantitative polymerase chain reaction (RO-PCR) analysis to determine whether frequent monitoring of EBV DNA to allow preemptive treatment is truly of value in patients after HSCT. More than 1300 samples from 85 recipients were analyzed. No patient with consistently low EBV DNA levels developed PTLD. Nine patients had a single episode with a high EBV load (more than 4000 EBV copies/μg peripheral blood mononuclear cell [PBMC] DNA), and 16 patients had high EBV loads detected on 2 or more occasions. Only 8 of these developed symptoms consistent with PTLD, and all were promptly and successfully treated with EBV-specific cytotoxic T cells or CD20 monoclonal antibody. Hence, quantitative measurement of EBV DNA may best be used to enable the prompt rather than the preemptive treatment of PTLD.

Original language	English (US)
Pages (from-to)	3979-3981
Number of pages	3
Journal	Blood
Volume	103
Issue number	10
DOIs	https://doi.org/10.1182/blood-2003-12-4287
State	Published - May 15 2004

ASJC Scopus subject areas

Biochemistry
Immunology
Hematology
Cell Biology

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title = "Prompt versus preemptive intervention for EBV lymphoproliferative disease",

abstract = "Posttransplantation lymphoproliferative disorders (PTLDs) caused by uncontrolled expansion of Epstein-Barr virus (EBV)-infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by an increase in EBV DNA in peripheral blood mononuclear cells. We used real-time quantitative polymerase chain reaction (RO-PCR) analysis to determine whether frequent monitoring of EBV DNA to allow preemptive treatment is truly of value in patients after HSCT. More than 1300 samples from 85 recipients were analyzed. No patient with consistently low EBV DNA levels developed PTLD. Nine patients had a single episode with a high EBV load (more than 4000 EBV copies/μg peripheral blood mononuclear cell [PBMC] DNA), and 16 patients had high EBV loads detected on 2 or more occasions. Only 8 of these developed symptoms consistent with PTLD, and all were promptly and successfully treated with EBV-specific cytotoxic T cells or CD20 monoclonal antibody. Hence, quantitative measurement of EBV DNA may best be used to enable the prompt rather than the preemptive treatment of PTLD.",

author = "Wagner, {Hans Joachim} and Cheng, {Yee Chung} and Huls, {M. Helen} and Gee, {Adrian P.} and Ingrid Kuehnle and Krance, {Robert A.} and Brenner, {Malcolm K.} and Rooney, {Cliona M.} and Heslop, {Helen E.}",

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AU - Wagner, Hans Joachim

AU - Cheng, Yee Chung

AU - Huls, M. Helen

AU - Gee, Adrian P.

AU - Kuehnle, Ingrid

AU - Krance, Robert A.

AU - Brenner, Malcolm K.

AU - Rooney, Cliona M.

AU - Heslop, Helen E.

PY - 2004/5/15

Y1 - 2004/5/15

N2 - Posttransplantation lymphoproliferative disorders (PTLDs) caused by uncontrolled expansion of Epstein-Barr virus (EBV)-infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by an increase in EBV DNA in peripheral blood mononuclear cells. We used real-time quantitative polymerase chain reaction (RO-PCR) analysis to determine whether frequent monitoring of EBV DNA to allow preemptive treatment is truly of value in patients after HSCT. More than 1300 samples from 85 recipients were analyzed. No patient with consistently low EBV DNA levels developed PTLD. Nine patients had a single episode with a high EBV load (more than 4000 EBV copies/μg peripheral blood mononuclear cell [PBMC] DNA), and 16 patients had high EBV loads detected on 2 or more occasions. Only 8 of these developed symptoms consistent with PTLD, and all were promptly and successfully treated with EBV-specific cytotoxic T cells or CD20 monoclonal antibody. Hence, quantitative measurement of EBV DNA may best be used to enable the prompt rather than the preemptive treatment of PTLD.

AB - Posttransplantation lymphoproliferative disorders (PTLDs) caused by uncontrolled expansion of Epstein-Barr virus (EBV)-infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by an increase in EBV DNA in peripheral blood mononuclear cells. We used real-time quantitative polymerase chain reaction (RO-PCR) analysis to determine whether frequent monitoring of EBV DNA to allow preemptive treatment is truly of value in patients after HSCT. More than 1300 samples from 85 recipients were analyzed. No patient with consistently low EBV DNA levels developed PTLD. Nine patients had a single episode with a high EBV load (more than 4000 EBV copies/μg peripheral blood mononuclear cell [PBMC] DNA), and 16 patients had high EBV loads detected on 2 or more occasions. Only 8 of these developed symptoms consistent with PTLD, and all were promptly and successfully treated with EBV-specific cytotoxic T cells or CD20 monoclonal antibody. Hence, quantitative measurement of EBV DNA may best be used to enable the prompt rather than the preemptive treatment of PTLD.

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Prompt versus preemptive intervention for EBV lymphoproliferative disease

Abstract

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