Abstract
Epstein-Barr virus (EBV) is a ubiquitous virus belonging to the human γ-herpes virus subfamily. After primary infection, EBV maintains a life-long latent infection. A major concern is that EBV can cause a diverse range of neoplasms and autoimmune diseases. In addition, patients undergoing hematopoietic stem cell transplantation or solid organ transplantation can experience post-transplant lymphoproliferative disorders (PTLDs) due to dysfunction or suppression of host’s immune system, or uncontrolled proliferation of EBV-infected cells. In recent years, the number of EBV-associated PTLD cases has increased. This review focuses on the current understandings of EBV-associated PTLD pathogenesis, as well as the risk factors and clinical outcomes for patients after allogeneic stem cell transplantation.
Highlights
Epstein-Barr virus (EBV) infects more than 90% of the adult population worldwide at some point in their lives, usually with no ill effects [1]
EBV has been identified as the cause of several human cancers, including nasopharyngeal carcinoma and Hodgkin’s lymphoma; it is responsible for post-transplant lymphoproliferative disorder (PTLD) [3]
The 2017 revised 4th edition of the World Health Organization classification recognizes four different entities: non-destructive PTLD characterized histologically by a lack of architectural effacement, polymorphic PTLD characterized by a full spectrum of lymphoid maturation but not satisfying the criteria for lymphoma, monomorphic PTLD (B-cell neoplasms and T/NK-cell neoplasms which are classified in more detail according to the historical characteristics of the lymphoma they most resemble), and classical Hodgkin lymphoma PTLD (Table 1)
Summary
Epstein-Barr virus (EBV) infects more than 90% of the adult population worldwide at some point in their lives, usually with no ill effects [1]. EBV was first identified in 1964 from a patient with Burkitt’s lymphoma, suggesting that EBV is a causative agent of human cancer [2]. EBV maintains a life-long latent infection of memory B-cells; the virus can cause a range of neoplasms attributable to dysregulated proliferation of EBV-infected B-cells due to dysfunction or suppression of the host immune system after transplantation. The most common histological subtype of monomorphic PTLD is diffuse large B-cell lymphoma, which accounts for ~60% of cases. Other subtypes such as Burkitt lymphoma, plasma cell neoplasms and T-cell lymphoma have been reported [6,7].
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