Hematopoietic Stem Cell Transplantation for the Treatment of Epstein-Barr Virus-Associated T- or NK-Cell Lymphoproliferative Diseases and Associated Disorders

• Published in: Frontiers in pediatrics Vol. 6; p. 334
• Main Authors: Sawada, Akihisa, Inoue, Masami
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 06.11.2018
• Subjects: CAEBV; EBV; HLH; HSCT; LPD; Pediatrics; PTLD; EBV; LPD; PTLD; CAEBV; HLH; HSCT
• ISSN: 2296-2360; 2296-2360
• DOI: 10.3389/fped.2018.00334

Chronic active Epstein-Barr virus infection (CAEBV) is a prototype of EBV-associated T- and/or NK-cell (EBV T/NK-cell) lymphoproliferative disorders. Most subtypes of these are lethal. We established a unified treatment strategy composed of step 1 (immunochemotherapy: steroids, cyclosporine A, and etoposide), step 2 (multi-drug block chemotherapy), and step 3 (allogeneic hematopoietic stem cell transplantation; HSCT) for CAEBV and its related diseases. Allogeneic HSCT is the only cure for CAEBV with few exceptions. Primary-EBV infection-associated hemophagocytic lymphohistiocytosis (primary-EBV HLH) is also an EBV T/NK-cell lymphoproliferation. The nature of EBV T/NK cells in CAEBV and those in primary-EBV HLH differ. In primary-EBV HLH, most patients need step 1 only and some require step 2 for the successful induction of apoptosis in EBV-infected T cells; however, some exceptional patients require HSCT. We herein present our single institutional experience of CAEBV and primary-EBV HLH, together with that of post-transplant EBV T/NK-cell lymphoproliferative disease. We also discuss some practical points on HCST with a review of the literature.