Management of Epstein-Barr Virus Infection

General Principles

• The management of EBV infection should focus on supportive care for uncomplicated cases, while implementing specific therapeutic strategies for severe manifestations like post-transplant lymphoproliferative disorders (PTLD), with rituximab being the first-line treatment for EBV-PTLD, as recommended by the European Society for Medical Oncology 1, 2

Management of EBV in High-Risk Populations

• All allogeneic hematopoietic stem cell transplant (HSCT) patients and donors should be tested for EBV antibodies before transplantation, according to the European Society for Medical Oncology guidelines 5
• High-risk patients (those receiving T-cell depleted grafts, anti-thymocyte globulin, or with GvHD) should undergo prospective monitoring of EBV DNA-emia by quantitative PCR, as suggested by the American Society for Transplantation and Cellular Therapy 5

Management of EBV-PTLD

• Rituximab (375 mg/m²) administered once weekly is the treatment of choice for EBV-PTLD, with positive outcomes in approximately 70% of patients, as recommended by the American Society of Hematology 4, 6
• Reduction of immunosuppressive therapy should be combined with rituximab whenever possible, according to the National Comprehensive Cancer Network guidelines 4, 6

Preemptive Therapy for EBV DNA-emia

• Significant EBV DNA-emia without clinical symptoms is an indication for preemptive therapy with rituximab, as suggested by the European Society for Medical Oncology 3, 4
• Rituximab (375 mg/m²) should be administered once weekly (typically 1-4 doses) until EBV DNA-emia negativity, according to the American Society for Transplantation and Cellular Therapy 3, 4