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Epstein–Barr virus reactivation after allogeneic hematopoietic stem cell transplantation: multifactorial impact on transplant outcomes

Bone Marrow Transplantation volume 55, pages 1754–1762 (2020)Cite this article

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Abstract

Epstein–Barr virus (EBV) reactivation after allogeneic hematopoietic cell transplantation (allo-HCT) is one of the major concerns that may lead to fatal EBV diseases. However, updated data are needed because of the remarkable evolution of the HCT protocol and donor selection. We conducted a retrospective study that enrolled 890 allo-HCT recipients. Independent risk factors for EBV reactivation were use of antithymocyte globulin, haploidentical donor, and the presence of chronic graft-versus-host disease. The cumulative incidence of EBV reactivation was 2.9%, 11.7%, 27.3%, and 41.9% for patients with 0, 1, 2, and 3 risk factors, respectively (P < 0.001). Posttransplant lymphoproliferative disorders (PTLDs) occurred in seven patients. EBV reactivation was associated with inferior survival in recipients who survived more than 2 years post-HCT (P < 0.001) but might time-dependently benefit those patients with malignancies by decreasing relapse incidence (P = 0.046). A decreased relapse incidence was observed 1 year after HCT for recipients at first or second remission (P = 0.042) and in the first year post-HCT for recipients with advanced diseases (P = 0.032). We concluded that with current management, PTLDs were efficiently controlled, but EBV reactivation still had a multifactorial impact on transplant outcomes. Multicenter prospective studies are warranted to validate these findings.

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Fig. 1: Incidence of EBV reactivation after HCT.
Fig. 2: Multivariate analysis of risk factors for EBV reactivation after HCT.
Fig. 3: Accumulative effect of risk factors on EBV reactivation.
Fig. 4: Overall survival of recipients between EBV-positive and negative group.
Fig. 5: Transplantation outcome of recipients between EBV-positive and negative group beyond 2 years.
Fig. 6: Cumulative incidence of relapse between EBV-positive and negative group by time since transplantation.

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Acknowledgements

This work was supported by the National Science Foundation of China (Nos. 81700173 and 81730003), Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), National Key R&D Program of China (2016YFC0902800), Innovation Capability Development Project of Jiangsu Province (BM2015004), National Science and Technology Major Project (2017ZX09304021), National Key R&D Program of China (2017YFA0104502), Jiangsu Medical Outstanding Talents Project (JCRCA2016002), and Jiangsu Provincial Key Medical Center (YXZXA2016002).

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  1. These authors contributed equally: Yuhua Ru, Xiang Zhang, Tiemei Song

Authors and Affiliations

  1. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Yuhua Ru, Xiang Zhang, Tiemei Song, Yiyang Ding, Ziling Zhu, Yi Fan, Yang Xu, Aining Sun, Huiying Qiu, Zhengming Jin, Xiaowen Tang, Yue Han, Zhengzheng Fu, Suning Chen, Xiao Ma, Feng Chen, Jia Chen & Depei Wu

  2. Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

    Yuhua Ru, Xiang Zhang, Tiemei Song, Yiyang Ding, Ziling Zhu, Yi Fan, Yang Xu, Aining Sun, Huiying Qiu, Zhengming Jin, Xiaowen Tang, Yue Han, Zhengzheng Fu, Suning Chen, Xiao Ma, Feng Chen, Jia Chen & Depei Wu

  3. Key Laboratory of Stem Cells and Biomedical Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China

    Yuhua Ru, Xiang Zhang, Tiemei Song, Yiyang Ding, Ziling Zhu, Yi Fan, Yang Xu, Aining Sun, Huiying Qiu, Zhengming Jin, Xiaowen Tang, Yue Han, Zhengzheng Fu, Suning Chen, Xiao Ma, Feng Chen, Jia Chen & Depei Wu

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Ru, Y., Zhang, X., Song, T. et al. Epstein–Barr virus reactivation after allogeneic hematopoietic stem cell transplantation: multifactorial impact on transplant outcomes. Bone Marrow Transplant 55, 1754–1762 (2020). https://doi.org/10.1038/s41409-020-0831-7

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