Incidence, risk factors, and clinical significance of Epstein–Barr virus reactivation in myelodysplastic syndrome after allogeneic haematopoietic stem cell transplantation
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Epstein–Barr virus (EBV) reactivation is a life-threatening complication after allogeneic haematopoietic stem cell transplantation (allo-HSCT). In this study, we investigated the characteristics of EBV reactivation in 186 consecutive myelodysplastic (MDS) patients who underwent allo-HSCT in our centre. In 35 patients (18.8%) who experienced EBV reactivation after allo-HSCT, the median onset was 53 days (range 4–381 days). The cumulative incidence of EBV reactivation at the first, sixth, and twelfth month after allo-HSCT was 10.7%, 15.1%, and 17.9%, respectively. Twenty-five patients (71.4%) received pre-emptive rituximab therapy, and no patients developed post-transplant lymphoproliferative disorders. Stem cell source was proven to be a risk factor correlated with EBV reactivation. The cumulative incidence of relapse in the EBV-positive group was 11.4%, 25.2%, and 31.0% at the first, second, and third year after transplantation, respectively, being significantly higher than the corresponding 6.8%, 10.2%, and 10.2%, in the EBV-negative group (P = 0.014). Prognostic analysis showed that EBV reactivation was an independent risk factor for relapse-free survival (RFS). Patients in the EBV-positive group showed obviously shorter RFS than those in the EBV-negative group, with 3-year RFS of 62% and 85%, respectively (P = 0.017).
KeywordsEpstein–Barr virus Myelodysplastic syndrome Stem cell transplantation Relapse Prognosis
We would like to thank the patients and the physicians from the Department of Hematology, the First Affiliated Hospital of Soochow University.
This study was supported by grants from the National Natural Science Foundation of China (Grant Nos. 81100342, 81270591, 81270617, 81470346, 81670132), Jiangsu Province of China (BE2016665, BRA2011218), Jiangsu Provincial Special Program of Medical Science (BL2012005), Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), National Key Research and Development Program (2016YFC0902800), and Innovation Capability Development Project of Jiangsu Province (BM2015004).
Compliance with ethical standards
The study was performed in accordance with institutional guidelines and was approved by the Committees for the Ethical Review of Research at the First Affiliated Hospital of Suchow University. Informed consent was obtained from the patients before data collection.
Conflict of interest
The authors declare that they have no conflict of interest.
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