Spectrum Of Epstein-Barr Virus-Associated Diseases In Recipients Of Allogeneic Hematopoietic Stem Cell Transplantation

Background. Epstein-Barr virus (EBV) infection may result in a spectrum of diseases in recipients of transplant. The aim of this study is to investigate the incidence, clinical characteristics, and prognosis of the spectrum of EBV-associated diseases in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods. A total of 263 recipients undergoing allo-HSCT were prospectively enrolled. The blood EBV-DNA loads were regularly monitored by quantitative real-time polymerase chain reaction.Results. The 3-year cumulative incidence of total EBV-associated diseases, posttransplantation lymphoproliferative diseases (PTLD), EBV fever, and EBV end-organ diseases (pneumonia, encephalitis/myelitis, and hepatitis) were 15.6%+/- 2.5%, 9.9%+/- 2.0%, 3.3%+/- 1.3%, and 3.3%+/- 1.2% (2.2%+/- 1.0%, 1.6%+/- 0.8%, and 0.9%+/- 0.6%), respectively. Fever was the most common symptom of EBV-associated diseases. Patients with PTLD had better response rate to rituximab-based treatments compared with those with EBV end-organ diseases (including PTLD accompanied by EBV end-organ diseases) (P=0.014). The 3-year overall survival was 37.3%+/- 13.7%, 100.0%, and 0.0%+/- 0.0% in patients with PTLD, EBV fever, and EBV end-organ diseases (P=0.001).Conclusions. EBV-associated diseases other than PTLD are not rare in the recipients of allo-HSCT. The clinical manifestations of EBV end-organ diseases are similar to PTLD. EBV end-organ diseases had poorer response to rituximab-based therapy compared with PTLD.