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Epstein-Barr Virus Infection and Posttransplant Lymphoproliferative Disease

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Principles and Practice of Transplant Infectious Diseases

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Abstract

Epstein-Barr virus (EBV) is an oncogenic herpesvirus with a worldwide seroprevalence of >90%. Like all members of the herpesvirus family, EBV establishes infection that persists for the lifetime of the host. In most healthy patients, both primary EBV infection and lifelong latent infection are benign. However, in an immunocompromised host, such as a transplant recipient, either primary infection or reactivation of latent infection can lead to severe disease. The most significant EBV-associated illness that occurs following solid-organ or hematopoietic stem cell transplantation is posttransplant lymphoproliferative disease (PTLD). In this chapter, we provide an overview of the virus, its life cycle, host immune control, diagnostic testing, and efforts at vaccine development. Particular focus is given to the clinical features, diagnosis, and management of EBV-associated PTLD.

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Abbreviations

AIM:

Acute infectious mononucleosis

AP-1:

Activating protein-1

ATG:

Antithymocyte globulin

BCR:

B-cell receptor

ChIP-Seq:

Chromatin immunoprecipitation-sequencing

CIITA:

Class II, major histocompatibility complex, transactivator

CNS:

Central nervous system

CR:

Complete response

CT:

Computed tomography

CTL:

Cytotoxic lymphocytes

D:

Diffuse

DLBCL:

Diffuse large B-cell lymphoma

DLI:

Donor lymphocyte infusion

DNA:

Deoxyribonucleic acid

EA:

Early antigen

EBER:

Epstein-Barr virus-encoded ribonucleic acid

EBNA:

Epstein-Barr virus nuclear antigen

EBV:

Epstein-Barr virus

ELISA:

Enzyme-linked immunosorbent assays

GC:

Germinal center

gp350:

Glycoprotein 350

GVHD:

Graft versus host disease

HDACi:

Histone deacetylation inhibitors

HIV:

Human immunodeficiency virus

HL:

Hodgkin lymphoma

HLA:

Human leukocyte antigen

HSCT:

Hematopoietic stem cell transplantation

IC50:

Half maximal inhibitory concentration

IF:

Immunofluorescence

IL-10:

Interleukin 10

LCL:

Lymphoblastoid cell line

LMP:

Latent membrane protein

MHC:

Major histocompatibility complex

miRNA:

MicroRNA

NIH:

National Institutes of Health

NK:

Natural killer

NPC:

Nasopharyngeal carcinoma

ORR:

Objective response rate

PCR:

Polymerase chain reaction

PET:

Positron emission tomography

PR:

Partial response

PTLD:

Posttransplant lymphoproliferative disease

R:

Restricted

RI:

Reduction of immunosuppression

RNA:

Ribonucleic acid

RR:

Response rate

RS:

Reed-Sternberg

SOT:

Solid-organ transplantation

TAP:

Transporter associated with antigen processing

UCBT:

Umbilical cord blood transplantation

VCA:

Viral capsid antigen

VZV:

Varicella zoster virus

WHO:

World Health Organization

XLP:

X-linked lymphoproliferative disease

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Division of Infectious Diseases, Boston, MA, USA

    Benjamin E. Gewurz & Sheila Bond

  2. Baylor College of Medicine, Department of Pediatrics, Infectious Diseases, Houston, TX, USA

    Elizabeth Moulton

  3. Dana-Farber Cancer Institute, Division of Medical Oncology, Boston, MA, USA

    Amy Bessnow & David M. Weinstock

Authors
  1. Benjamin E. Gewurz
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  2. Elizabeth Moulton
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  3. Amy Bessnow
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  4. David M. Weinstock
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  5. Sheila Bond
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Correspondence to David M. Weinstock .

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Editors and Affiliations

  1. Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar

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Gewurz, B.E., Moulton, E., Bessnow, A., Weinstock, D.M., Bond, S. (2019). Epstein-Barr Virus Infection and Posttransplant Lymphoproliferative Disease. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_38

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