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学科主题: 临床医学
题名:
Molecular monitoring and stepwise preemptive therapy for Epstein-Barr virus viremia after allogeneic stem cell transplantation
作者: Liu, Qifa1; Xuan, Li1; Liu, Hui1; Huang, Fen1; Zhou, Hongsheng1; Fan, Zhiping1; Zhao, Ke1; Wu, Meiqing1; Xu, Lanping2; Zhai, Xiao1; Zhang, Fuhua1; Liu, Can1; Sun, Jing1; Huang, Xiaojun2
刊名: AMERICAN JOURNAL OF HEMATOLOGY
发表日期: 2013-07-01
DOI: 10.1002/ajh.23452
卷: 88, 期:7, 页:550-555
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Hematology
研究领域[WOS]: Hematology
关键词[WOS]: POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE ; POLYMERASE-CHAIN-REACTION ; VERSUS-HOST-DISEASE ; HIGH-RISK PATIENTS ; VIRAL LOAD ; HEMATOLOGICAL MALIGNANCIES ; EBV REACTIVATION ; DISORDERS ; RITUXIMAB ; RECIPIENTS
英文摘要:

The optimal preemptive therapy for Epstein-Barr virus (EBV)-associated diseases remains under discussion. We developed a stepwise preemptive therapy (antiviral agents and reduction of immunosuppressants [RI] followed by rituximab) for EBV viremia, based on duration of EBV viremia and changes of viral loads. The blood EBV-DNA loads were regularly monitored by quantitative real-time polymerase chain reaction in 251 recipients undergoing allogeneic stem cell transplantation. The 3-year cumulative incidence of EBV viremia and EBV-associated diseases were 31.1%+/- 3.1% and 15.6%+/- 2.5%, which rose steeply with greater numbers of major risk factors. Of the 64 patients undergoing first-step preemption, 24 achieved complete response (CR) and 40 showed no response, including 25 progressing to EBV-associated diseases. The effective rates of antiviral agents and RI plus antiviral agents were 2/16 and 22/48 (P=0.017). Fourteen achieved CR and one progressed to lymphoproliferative disease in the 15 patients undergoing rituximab preemption. Of the 26 patients progressing to EBV-associated diseases during preemptive therapy, 20 obtained CR in the 23 cases with rituximab-based treatments. The preemptive efficacy of RI plus antiviral agents was correlated with the numbers of major risk factors (rs=-0.298; P=0.04). B-cell reconstitution was significantly delayed for at least 6 months in patients with rituximab preemption. The risk of herpesvirus infection was similar in patients who showed effective progress to first-step and rituximab preemption (P=0.094). RI plus antiviral agents could be given priority to low-risk patients, whereas more frequent monitoring of blood EBV-DNA and earlier preemptive rituximab should be advocated in high-risk patients. Am. J. Hematol. 88:550-555, 2013. (c) 2013 Wiley Periodicals, Inc.

语种: 英语
所属项目编号: 2011AA020105 ; 201202017 ; 81000231 ; 81270647 ; 81200388 ; 30971300 ; 2009A030200007 ; 2012B031800403 ; A2010010 ; 10451008004004158
项目资助者: National High Technology Research and Development Program of China (863 Program) ; National Public Health Grand Research Foundation ; National Natural Science Foundation of China ; Science and Technology Project of Guangdong Province of China ; Medical Scientific Research Foundation of Guangdong Province ; Guangdong Natural Science Foundation
WOS记录号: WOS:000320662200003
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/66884
Appears in Collections:北京大学第二临床医学院_血液科_期刊论文

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作者单位: 1.Southern Med Univ, Nanfang Hosp, Dept Hematol, Guangzhou 510515, Guangdong, Peoples R China
2.Peking Univ Peoples Hosp, Inst Hematol, Beijing 100044, Peoples R China

Recommended Citation:
Liu, Qifa,Xuan, Li,Liu, Hui,et al. Molecular monitoring and stepwise preemptive therapy for Epstein-Barr virus viremia after allogeneic stem cell transplantation[J]. AMERICAN JOURNAL OF HEMATOLOGY,2013,88(7):550-555.
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