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Epstein–Barr Virus Infection and Lymphoproliferative Disorders After Transplantation

  • Jutta K. Preiksaitis
  • Sandra M. Cockfield
  • Anthea C. Peters
Chapter

Abstract

Epstein–Barr virus (EBV) infection is highly prevalent in both transplant recipients and donors and plays an important role in the pathogenesis of most cases of posttransplant lymphoproliferative disorder (PTLD) seen early after transplant. Over the past decade an epidemiologic shift in PTLD incidence has occurred: PTLD occurring early posttransplant predominantly in high-risk recipients has decreased. This improvement has been attributed to preemptive prevention strategies in these patients and evolving immunosuppression regimens. Efforts have also been made to standardize assays measuring EBV viral load with the goal of improving inter-assay comparisons and standardizing practices. However, EBV-negative PTLD occurring late posttransplant is now emerging as the predominant PTLD subtype, particularly in solid organ transplant recipients. Further research efforts focused on the epidemiology, pathogenesis, and treatment of late PTLDs are required. A prospective, multicenter, controlled trial evaluating sequential therapy with the anti-CD20 monoclonal antibody rituximab followed by chemotherapy has demonstrated prolonged remissions with improved tolerability. But, given the lack of other comparable studies, the standard of care for treatment of PTLD cannot be established. Future therapeutic trials are needed to identify patients that can be spared from chemotherapy, and novel therapeutic approaches must be explored to prevent disease, improve outcomes, and expand the therapeutic armamentarium.

Keywords

Lymphoma Epstein–Barr virus Posttransplant lymphoproliferative disorder Solid organ transplantation Hematopoietic stem cell transplantation Hodgkin lymphoma Non-Hodgkin lymphoma 

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Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  • Jutta K. Preiksaitis
    • 1
  • Sandra M. Cockfield
    • 2
  • Anthea C. Peters
    • 3
  1. 1.Division of Infectious Diseases,Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Division of Nephrology, Department of MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Division of Hematology, Department of MedicineUniversity of AlbertaEdmontonCanada

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