Preemptive diagnosis and treatment of Epstein-Barr virus-associated post transplant lymphoproliferative disorder after hematopoietic stem cell transplant: An approach in development Journal Article

  

Authors:	Weinstock, D. M.; Ambrossi, G. G.; Brennan, C.; Kiehn, T. E.; Jakubowski, A.
Article Title:	Preemptive diagnosis and treatment of Epstein-Barr virus-associated post transplant lymphoproliferative disorder after hematopoietic stem cell transplant: An approach in development
Abstract:	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. © 2006 Nature Publishing Group. All rights reserved.
Keywords:	treatment outcome; survival rate; acute granulocytic leukemia; busulfan; fludarabine; clinical feature; review; rituximab; sensitivity and specificity; polymerase chain reaction; disease association; stem cell transplant; cyclophosphamide; melphalan; stem cell transplantation; hematopoietic stem cell transplantation; chronic myeloid leukemia; prediction; risk factor; thiotepa; acute lymphoblastic leukemia; lymphocytopenia; hla matching; whole body radiation; death; medical research; cytotoxic t lymphocyte; experience; graft versus host reaction; medical literature; dna, viral; lymphoproliferative disease; real time polymerase chain reaction; virus load; graft rejection; hla antigen; epstein barr virus; herpesvirus 4, human; thymocyte antibody; monoclonal antibody cd3; pcr; epstein-barr virus infections; lymphoproliferative disorders; recipient; virus dna; epstein-barr virus; lymphocyte transfer; leukocyte transfusion; post transplant lymphoproliferative disorder
Journal Title:	Bone Marrow Transplantation
Volume:	37
Issue:	6
ISSN:	0268-3369
Publisher:	Nature Publishing Group
Date Published:	2006-03-01
Start Page:	539
End Page:	546
Language:	English
DOI:	10.1038/sj.bmt.1705289
PUBMED:	16462755
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33644880019&partnerID=40&md5=80b1a432c98d421a81c0aa820d166ea6
Notes:	--- - "Cited By (since 1996): 50" - "Export Date: 4 June 2012" - "CODEN: BMTRE" - "Source: Scopus"

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