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[Clinical risks analysis of EBV infection in patients with allogeneic hematopoietic stem cell transplantation].

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Bao XB, Zhu Q, Qiu HY, Chen F, Xue SL, Ma X, Sun AN, Wu DP,


Bao XB, Zhu Q, Qiu HY, Chen F, Xue SL, Ma X, Sun AN, Wu DP, (click to view)

Bao XB, Zhu Q, Qiu HY, Chen F, Xue SL, Ma X, Sun AN, Wu DP,

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Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 37(2) 138-143 doi 10.3760/cma.j.issn.0253-2727.2016.02.011

Abstract

Objective: To analyze the prevalence of Epstein Barr Virus (EBV)infection in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: The occurrence of EBV viremia, EBV disease and post-transplant lymphoproliferative disease (PTLD)were retrospectively analyzed in 736 patients received allo-HSCT in single-center from 1st January 2012 through July 31th, 2014. Results: Of 736 patients (302 male and 434 females)with a median age of 31 (2 to 62) years old, EBV infection occurred in 181 patients, the total incidence of EBV infection was 27.6%, with a median time of 57 (16 to 829)days. The cumulative incidences of probable EBV disease and PTLD were 7.2% (13/181)and 2.8% (5/181). Viral load higher than 1.0×10(4)copies/ml occurs in 130 patients, of which 67 patients received rituximab as pre-empty prophylaxis and significantly reduced the incidences of probable EBV disease and PTLD (6.0% vs 22.2%,P=0.009). The mortality was 27.6% in all patients with EBV infection: 24.5% in EBV viremia, 53.8% in probable EBV disease, and 60.6% in PTLD. By univariate and multivariate analysis, the use of anti-thymocyte globulin (ATG), HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The time of first EBV reactivation was closely related with cGVHD(OR=0.620, 95%CI 0.453-0.849,P=0.003)and bone marrow or cord blood (OR=1.156, 95%CI 1.022-2.250,P=0.039) as source of stem cells for transplantation. Conclusion: EBV reactivation is a common complication in patients with allo-HSCT, especially high mortality in PTLD and probable EBV disease. The use of ATG, HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The usage of rituximab as pre-empty prophylaxis may reduce the incidences of probable EBV disease and PTLD.

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