In patients with myelodysplastic syndrome (MDS) who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT), Epstein-Barr virus (EBV) reactivation following alloHSCT may be related to worse relapse-free survival (RFS), according to data published in the Annals of Hematology.

Additionally, marrow-derived stem cells, myeloablative conditioning, rabbit antithymocyte globulin for graft-versus-host-disease prophylaxis, haploidentical donor transplantation, and not receiving supportive treatment (decitabine or chemotherapy) were found to correlate with a higher cumulative incidence of EBV reactivation.

Reactivation of EBV can be life threatening after alloHSCT. In this study, researchers assessed the characteristics of EBV reactivation by evaluating 186 consecutive patients with MDS who underwent alloHSCT.

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Approximately 1 in 5 patients (18.8%; 35 patients) experienced EBV reactivation following alloHSCT. The median time to onset of EBV reactivation was 53 days.

The cumulative incidence of EBV reactivation was 10.7% at 1 month after transplant, 15.1% at 6 months after transplant, and 17.9% at 12 months after transplant. The majority of patients with EBV reactivation (71.4%; 25 patients) received preemptive rituximab, and no patients developed lymphoproliferative disorders after transplant.

The cumulative incidence of relapse in EBV-positive patients was 11.4% in the first year, 25.2% in the second year, and 31.0% in the third year following transplant. In comparison, in EBV-negative patients, the cumulative incidence of relapse was 6.8% in the first year, 10.2% in the second year, and 10.2% in the third year following alloHSCT (P =.014).

EBV reactivation was found to be an independent risk factor for inferior RFS; patients with EBV reactivation experienced a 3-year RFS rate of 62% compared with a RFS rate of 85% in the EBV-negative group (P =.017).


  1. Wang H, Zhang TT, Qi JQ, et al. Incidence, risk factors, and clinical significance of Epstein–Barr virus reactivation in myelodysplastic syndrome after allogeneic haematopoietic stem cell transplantation [published online February 4, 2019]. Ann Hematol. doi:10.1007/s00277-019-03603-3

This article originally appeared on Hematology Advisor