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Ratiu C, Dufresne SF, Thiant S, Roy J. Epstein-Barr Virus Monitoring after an Allogeneic Hematopoietic Stem Cell Transplant: Review of the Recent Data and Current Practices in Canada. Curr Oncol 2024; 31:2780-2795. [PMID: 38785492 PMCID: PMC11119229 DOI: 10.3390/curroncol31050211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Epstein-Barr virus-related post-transplantation lymphoproliferative disorder (EBV-PTLD) is a serious complication following hematopoietic stem cell transplantation (HSCT). A pre-emptive strategy using rituximab, which aims to manage patients early at the time of EBV reactivation to avoid PTLD, has been recommended by the most recent ECIL-6 guidelines in 2016. However, there is still a great heterogeneity of viral-load monitoring protocols, targeted patient populations, and pre-emptive treatment characteristics between centers, making precise EBV monitoring recommendations difficult. We conducted a literature review from the most recent publications between 1 January 2015 and 1 August 2023, to summarize the emerging data on EBV-PTLD prevention strategies in HSCT recipients, including the EBV-DNA threshold and use of rituximab. We also present the results of a survey of current practices carried out in 12 of the main HSCT centers across Canada. We confirm that pre-emptive rituximab remains an efficient strategy for EBV-PTLD prevention. However, there is an urgent need to perform prospective, randomized, multicentric trials with larger numbers of patients reflecting current practices to determine the best clinical conduct with regards to rituximab dosing, timing of treatment, and criteria to initiate treatments. Longer follow-ups will also be necessary to assess patients' long-term outcomes.
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Affiliation(s)
- Claire Ratiu
- Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Simon F. Dufresne
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Division of Infectious Diseases and Clinical Microbiology, Department of Medicine, Maisonneuve-Rosemont Hospital, Montréal, QC H1T 2M4, Canada
- Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montréal, QC H1T 2M4, Canada
| | - Stéphanie Thiant
- Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montréal, QC H1T 2M4, Canada
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Maisonneuve-Rosemont Hospital, 5415 de l’Assomption, Montréal, QC H1T 2M4, Canada
| | - Jean Roy
- Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre de Recherche de l’Hôpital Maisonneuve-Rosemont, Montréal, QC H1T 2M4, Canada
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Maisonneuve-Rosemont Hospital, 5415 de l’Assomption, Montréal, QC H1T 2M4, Canada
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Evaluation of the sample-to-result, random access NeuMoDx platform for viral load testing of Cytomegalovirus and Epstein Barr virus in clinical specimens. J Clin Virol 2022; 149:105122. [DOI: 10.1016/j.jcv.2022.105122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022]
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3
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Salmona M, Stefic K, Mahjoub N, de Fontbrune FS, Maylin S, Simon F, Scieux C, Socié G, Mazeron MC, LeGoff J. Automated quantification of Epstein-Barr virus in whole blood for post-transplant lymphoproliferative disorders monitoring. Virol J 2020; 17:20. [PMID: 32014036 PMCID: PMC6998838 DOI: 10.1186/s12985-020-1285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Standardized and sensitive assays for Epstein Barr Virus (EBV) are needed to define universal cutoff for treatment initiation in allogeneic hematopoietic stem cells transplant recipients. In a context of accreditation and the availability of EBV international standard, we evaluated the Abbott RealTime EBV (RT) assay for EBV quantification in whole blood. Methods The RT assay was compared on 282 prospective clinical samples with the Artus EBV PCR Kit V1 assay (V1) and we analyzed the kinetics of EBV load in 11 patients receiving rituximab treatment. Results The estimated limit of detection was 88 IU/mL. The assay was linear (r2 = 0.9974) in the range of all samples tested (100 to 1,000,000 IU/mL). Intra-assay coefficients of variation (CV) ranged between 0.35 and 1.35%, and inter-assay CV between 3.40 and 4.5%. On samples above the limit of quantification, the two assays were strongly correlated. EBV RT values were on average 0.30 log10 IU/mL lower than those measured with the V1 assay. In patients treated with rituximab, the RT assay remained positive in 5 patients at the time it dropped below undetectable levels with the V1 assay. Conclusions In conclusion, the RT assay is a reliable assay for EBV load in whole blood. Its sensitivity will enable to estimate the kinetics of EBV load and the impact of treatments to control EBV reactivations.
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Affiliation(s)
- Maud Salmona
- Université de Paris Diderot, INSERM U976, Paris, France. .,Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France.
| | - Karl Stefic
- Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France.,Université de Tours, INSERM U1259, Tours, France
| | - Nadia Mahjoub
- Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Sarah Maylin
- Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
| | - François Simon
- Université de Paris Diderot, INSERM U976, Paris, France.,Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Catherine Scieux
- Université de Paris Diderot, INSERM U976, Paris, France.,Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Gérard Socié
- Université de Paris Diderot, INSERM U976, Paris, France.,Hematology and Transplantation Unit, Hôpital Saint-Louis, APHP, Paris, France
| | - Marie-Christine Mazeron
- Université de Paris Diderot, INSERM U976, Paris, France.,Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Jérôme LeGoff
- Université de Paris Diderot, INSERM U976, Paris, France.,Laboratoire de Microbiologie, Hôpital Saint-Louis, APHP, Paris, France
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Epstein-Barr Virus-Associated Post-Transplantation Lymphoproliferative Disease in Patients Who Received Anti-CD20 after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2490-2500. [DOI: 10.1016/j.bbmt.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022]
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Bontems S, Boreux R, Capraro V, Huynen P, Descy J, Melin P, Hayette MP, Meex C. Evaluation of the Abbott RealTime quantitative CMV and EBV assays using the maxCycle protocol in a laboratory automation context. J Virol Methods 2019; 270:137-145. [PMID: 31121188 DOI: 10.1016/j.jviromet.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 01/08/2023]
Abstract
Real-time PCR are often used for the diagnosis and monitoring of Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections in susceptible populations. In this context, we evaluated the analytical performances of the Abbott RealTime CMV/EBV maxCycle protocol automated on the m2000 platform (Abbott). It was compared to our routinely-used procedure consisting of a NucleoMag® DNA extraction automated on a STARlet platform followed by manually processed CMV and EBV quantitative real-time PCR (Diagenode). In this study, we showed that both EBV assays exhibited a similar sensitivity but with a better precision for the EBV Abbott RealTime assay. For the CMV performances, the Abbott assay was more sensitive and more precise than our routine method. The use of WHO International Standards also indicated a slight underestimation of the viral loads (-0.25 log10 IU/mL and -0.21 log10 IU/mL for CMV and EBV assays respectively) while these were rather overestimated with the Starlet/Diagenode method (0.48 log10 IU/mL and 0.19 log10 IU/mL for CMV and EBV assays respectively). These trends were confirmed using relevant whole-blood clinical samples and external quality controls. The workflows were also compared and we highlighted a significant technician hands-on time reduction (-63%) using the Abbott CMV/EBV maxCycle automated protocol.
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Affiliation(s)
- Sébastien Bontems
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Raphaël Boreux
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Valérie Capraro
- Molecular Biology Platform, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Pascale Huynen
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Julie Descy
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Pierrette Melin
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Marie-Pierre Hayette
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
| | - Cécile Meex
- Laboratory of Clinical Microbiology, Unilab-Lg, CHU of Liege, 1 avenue de l'hopital, 4000 Liege, Belgium.
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Baron A, Gicquel A, Plantier JC, Gueudin M. Evaluation of four commercial extraction-quantification systems to monitor EBV or CMV viral load in whole blood. J Clin Virol 2019; 113:39-44. [PMID: 30870646 DOI: 10.1016/j.jcv.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/24/2018] [Accepted: 03/01/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Measurement of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) viral loads is commonly used to monitor posttransplant patients. Two new systems (eMAG/eSTREAM and Versant/kPCR) have been recently commercialized. OBJECTIVES To evaluate the performance of four systems to quantify CMV and EBV in whole blood. STUDY DESIGN Three extraction and real-time PCR amplification systems: m2000SP/RT (M2000), eMAG/eSTREAM (EMAG), and Versant/kPCR (KPCR) were compared with our routine system Qiasymphony/RGQ (QS/RGQ). The 4 systems were tested using 3 dilutions in triplicate according to the WHO international standard (WHO-IS) for intra-assay reproducibility; 56 whole blood samples (24 patients, 4 follow-ups) for CMV and 45 samples (27 patients, 3 follow-ups) for EBV. RESULTS For CMV, the mean of the WHO-IS (expected value: 4.7 Log IU/ml) was: QS/RGQ=4.84, M2000=4.61, EMAG=4.33, and KPCR=4.79. One patient (10 samples) presented a major underquantification by QS/RGQ. Of the 46 remaining samples, 41 were quantified with QS/RGQ, 43 with M2000, 33 with EMAG and 24 with KPCR. For EBV, the mean of the WHO-IS was: QS/RGQ=4.70, M2000=4.61, EMAG=4.62, and KPCR=4.57. Among the 45 samples, 43 were quantified with QS/RGQ, 39 with M2000, 40 with EMAG and 32 with KPCR. CONCLUSION The results obtained with the WHO-IS were very good. The results of patients' samples were well correlated with the announced sensitivity of each system. The elevated threshold of the KPCR CMV assay may be problematic for the follow-up of highly immunocompromised patients who require early introduction of treatment.
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Affiliation(s)
- Adeline Baron
- CHU de Rouen, Laboratoire de Virologie, F-76000 Rouen, France
| | - Albane Gicquel
- CHU de Rouen, Laboratoire de Virologie, F-76000 Rouen, France
| | | | - Marie Gueudin
- CHU de Rouen, Laboratoire de Virologie, F-76000 Rouen, France
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Lee JS, Yoon M, Kim MJ, Cho SI, Seong MW, Park SS, Kim JY. Evaluation of the new Abbott Real-Time EBV assay: fully automated quantification of EBV in whole blood by targeting BLLF1. Diagn Microbiol Infect Dis 2019; 94:135-139. [PMID: 30777343 DOI: 10.1016/j.diagmicrobio.2018.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
The accurate measurement of the Epstein-Barr virus (EBV) DNA level in the blood is required for managing EBV-associated diseases. A new commercial Abbott Real-Time EBV assay, which targets the BLLF1 gene, was evaluated on 120 clinical whole blood samples and the Qnostics EBV analytical panel. The limit of detection of the assay was 48.9 IU/mL (95% confidence interval, 48.1-49.8 IU/mL). The assay was linear from 2 to 5 log10 IU/mL (R2 = 0.997). The within-run coefficients of variation (CVs) ranged from 1.68% to 4.75% and the between-run CVs ranged from 1.73% to 12.83% for samples with high, medium, and low viral loads. EBV DNA loads measured by Abbott EBV assay strongly correlated with the results quantified by another commercial Nanogen EBV Real-Time Alert Q-PCR assay (r = 0.879, P < 0.0001). The fully automated Abbott Real-Time EBV assay targeting BLLF1 reduced both hands-on time and turnaround time and demonstrated a reliable performance for EBV DNA quantification in whole blood.
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Affiliation(s)
- Jee-Soo Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mihye Yoon
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Im Cho
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeon Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Kimura H, Kwong YL. EBV Viral Loads in Diagnosis, Monitoring, and Response Assessment. Front Oncol 2019; 9:62. [PMID: 30809508 PMCID: PMC6379266 DOI: 10.3389/fonc.2019.00062] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/22/2019] [Indexed: 12/26/2022] Open
Abstract
The quantification of circulating Epstein Barr virus (EBV) DNA loads has played an important role in the diagnosis and management of EBV-associated lymphoid malignancies. Viral load measurement is particularly useful for monitoring EBV-DNA in hematopoietic stem cell transplant patients, and for assessing the prognosis or response to therapy of EBV-associated intractable lymphomas like extranodal NK/T-cell lymphoma, nasal type. Cell-free EBV-DNA in plasma can be used as a biomarker for estimating the severity or prognosis of these lymphomas. In addition to plasma, whole blood has been used for the management of transplant patients. Although measuring EBV-DNA has been useful, there is a lack of standardization and the optimal specimens for measuring viral loads are unknown. This can be attributed to the different forms of EBV-DNA that exist in peripheral blood and the different pathologies that result from diverse EBV disease states. As a result, guidelines for EBV diagnosis or the initiation of treatment are unclear. However, the newly established World Health Organization standard for EBV quantification will encourage collaborative studies across institutions and countries to establish proper guidelines for EBV diagnosis and the initiation of treatment.
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Affiliation(s)
- Hiroshi Kimura
- Department of Virology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yok-Lam Kwong
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Engelmann I, Alidjinou EK, Lazrek M, Pouillaude JM, Ogiez J, Rose F, Duhamel A, Dewilde A, Hober D. Comparison of two commercial quantitative PCR assays for EBV DNA detection and their correlation with the first WHO International Standard for EBV. J Med Microbiol 2018; 67:529-536. [DOI: 10.1099/jmm.0.000702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Ilka Engelmann
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Enagnon Kazali Alidjinou
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Mouna Lazrek
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Jean-Marie Pouillaude
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Judith Ogiez
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - François Rose
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Alain Duhamel
- Université de Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Anny Dewilde
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
| | - Didier Hober
- Université de Lille, Faculté de Médecine, CHU Lille, Laboratoire de Virologie EA3610, F-59000 Lille, France
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Maylin S, Feghoul L, Salmona M, Herda A, Mercier-Delarue S, Simon F, Legoff J. Evaluation the Architect EBV VCA IgM, VCA IgG, and EBNA-1 IgG chemiluminescent immunoassays to assess EBV serostatus prior transplantation. J Med Virol 2017; 89:2003-2010. [PMID: 28661055 DOI: 10.1002/jmv.24889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 06/10/2017] [Indexed: 11/11/2022]
Abstract
Prior to transplantation of hematopoietic stem cells or solid organ, donor and recipient EBV serostatus has to be determined to assess risks of post-transplant lymphoproliferative disorders. Sensitivity of EBV Viral capsid antigens (VCA) IgG and EBV nuclear antigen-1 (EBNA-1) is critical to define past infection and a good specificity of VCA IgM is required to avoid any disqualification of cord blood (CB) units. Architect™ EBV antibody panel (Architect assay) providing a high throughput was compared to a semi-automated ELISA (Etimax assays Diasorin) to assess sensitivities and specificities of VCA and EBNA-1 IgG and VCA IgM on 419 sera collected from immunocompromised patients (n = 184) and from pregnant women who agreed to give CB cells (n = 235). Intra and inter-assay coefficient of variations ranged from 1.63% to 4.8% for VCA IgM, VCA IgG, and EBNA-1 IgG. Index of VCA IgG and IgM and EBNA IgG of the two assays were highly correlated. The concordance in the interpretation between the two assays was moderate for VCA IgM (kappa = 0.5), substantial for VCA IgG (kappa = 0.60) and good for EBNA-1 IgG (kappa = 0.75). Using serial dilutions of positive controls and in accordance with clinical results VCA IgG and EBNA IgG were detected at lower dilutions with Architect than Etimax. Conversely, 96.1% (74/77) of samples negative with Architect and positive with Etimax for VCA IgM did not have any heterophile antibodies and had VCA IgG and EBNA IgG antibodies supporting past infections. Architect™ EBV serology panel provided good sensitivities and specificities for EBV serostatus determination prior to transplantation.
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Affiliation(s)
- Sarah Maylin
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | - Linda Feghoul
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | - Maud Salmona
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
| | - Adel Herda
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | | | - François Simon
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
| | - Jérôme Legoff
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
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Vinuesa V, Solano C, Giménez E, Navarro D. Comparison of the artus Epstein–Barr virus (EBV) PCR kit and the Abbott RealTime EBV assay for measuring plasma EBV DNA loads in allogeneic stem cell transplant recipients. Diagn Microbiol Infect Dis 2017; 88:36-38. [DOI: 10.1016/j.diagmicrobio.2017.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/04/2017] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
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