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Epstein–Barr viral load in whole blood of adults with posttransplant lymphoproliferative disorder after solid organ transplantation does not correlate with clinical course

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Abstract

Posttransplant lymphoproliferative disease (PTLD) is closely linked to primary Epstein–Barr virus (EBV) infection. A defect of EBV specific cellular immunity is postulated to play a pivotal role in the etiology of PTLD, but there is some debate as to whether EBV load in the peripheral blood of transplant patients predicts onset of PTLD or relapse after treatment. The current prospective, single-center study was undertaken to investigate the impact of therapy on EBV load in adult patients with PTLD. Fifteen patients with PTLD after solid organ transplantation were included and of these, seven had EBV-associated PTLD. All 15 patients received Rituximab as primary therapy. In cases of treatment failure or relapse after Rituximab treatment, patients received polychemotherapy according to the cyclophosphamide, vincristine, doxorubicin, and prednisone regimen. At onset of PTLD, the median EBV load in the peripheral blood of patients was higher in EBV-associated PTLD than PTLD with no associated EBV infection. After Rituximab therapy, four of seven patients with EBV-associated PTLD achieved long-lasting complete remissions. However, in two of these patients, EBV load increased to reach levels as high as those recorded at onset of PTLD. Another patient showed a dramatic decline of EBV load after the first dose of Rituximab while suffering from progressive disease. The other patient relapsed after Rituximab monotherapy, but his viral load stayed low. In total, discordance in EBV load and clinical course was observed in five of the seven patients with EBV-associated PTLD. We conclude that in adult patients with PTLD, EBV load does not correlate with treatment response and is not suitable as a predictive marker for PTLD relapse.

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Acknowledgements

Stephan Oertel and Ralf Trappe contributed equally in this paper.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Charite-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Stephan Oertel, Ralf Ulrich Trappe, Kristin Zeidler, Matthias Papp-Vary, Marion Subklewe, Bernd Dörken & Hanno Riess

  2. Department of Oncology, Universitätsspital Zürich, Zürich, Switzerland

    Kristin Zeidler

  3. Department of Nephrology and Intensive Care, Charite-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany

    Nina Babel & Petra Reinke

  4. Thoracic Surgery, German Heart Institute, Berlin, Germany

    Manfred Hummel

  5. Department of Abdominal Surgery, Charite-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany

    Sven Jonas

  6. Institute of Virology, University Homburg/Saar, Homburg, Saar, Germany

    Barbara Gärtner

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  1. Stephan Oertel
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  2. Ralf Ulrich Trappe
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  3. Kristin Zeidler
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Correspondence to Ralf Ulrich Trappe.

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Oertel, S., Trappe, R.U., Zeidler, K. et al. Epstein–Barr viral load in whole blood of adults with posttransplant lymphoproliferative disorder after solid organ transplantation does not correlate with clinical course. Ann Hematol 85, 478–484 (2006). https://doi.org/10.1007/s00277-006-0109-1

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  • DOI: https://doi.org/10.1007/s00277-006-0109-1

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