Abstract
Epstein-Barr virus (EBV) infection is ubiquitous, most often asymptomatic, affecting more than 95 % of the world’s population; it is also a persistent viral infection associated with cancers in immunocompetent or immunocompromised individuals. In the hematopoietic stem cell (HSCT) transplant recipient or solid organ transplant recipient, the lack of control of EBV infection by the immune system may lead to lymphoproliferation or post-transplantation lymphoproliferative disorder (PTLD). The diagnosis of PTLD is based on clinical, biological and imaging arguments. The EBV viral load in the blood is a sensitive but not very specific marker of the occurrence of an PTLD. It is used in all centers in the follow-up of transplant patients, but no consensus exists to date on the viral load threshold from which preemptive treatment must be conducted. Each center should have its own experience of viral load monitoring: the virology laboratory (matrix, unit of measure or viral load threshold) and clinical services (interpretation of results in the clinical context). In a patient with rapidly increasing EBV viral load, preemptive EBV therapy may include the reduction of immunosuppression and / or the initiation of treatment with Rituximab, a monoclonal anti-CD20 monoclonal antibody targeting B cells.
Published Version
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