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Early detection of NPC is difficult because the nasopharynx is not readily amenable to clinical examination and symptoms of NPC are nonspecific.\u00a0The development of suitable biomarkers for early diagnosis of NPC as well as accurate monitoring of treatment response is needed urgently. In this exploratory pilot study, we have investigated the clinical significance of assessing plasma Epstein\u2013Barr virus (EBV) DNA load at diagnosis and during treatment. We found that EBV DNA is detectable at diagnosis in the majority of patients with nonendemic NPC and the absolute copy number of circulating EBV DNA per milliliter increases progressively with the stage of the disease. The viral load declined significantly with induction chemotherapy and definitive chemoradiation but showed a sharp rise at relapse. Patients with EBV DNA levels \u22651500\u2009copies\/ml had a higher risk of disease progression or relapse when compared with patients who had EBV DNA\u2009&lt;1500\u2009copies\/ml at baseline. Estimation of plasma EBV DNA may serve as an excellent noninvasive tool to monitor disease extent, response to therapy, and for better prediction of future relapse or progression\u2010free survival in a nonendemic NPC patient population.<\/jats:p>","DOI":"10.1002\/jmv.27440","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T04:21:46Z","timestamp":1636431706000},"page":"720-728","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Cell\u2010free EBV DNA as a biomarker during clinical management of nasopharyngeal carcinoma in a nonendemic region"],"prefix":"10.1002","volume":"94","author":[{"given":"Raja","family":"Pramanik","sequence":"first","affiliation":[{"name":"Department of Medical Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalabh","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preity","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahitagni","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baibaswata","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok","family":"Thakar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head Neck Surgery All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8262-4949","authenticated-orcid":false,"given":"Sampa","family":"Ghose","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology All India Institute of Medical Sciences  New Delhi Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-06-0353"},{"key":"e_1_2_9_4_1","volume-title":"Pathology and Genetics of Head and Neck Tumours","author":"Barnes L","year":"2020"},{"issue":"12","key":"e_1_2_9_5_1","first-page":"581","article-title":"Epstein\u2010Barr virus and nasopharyngeal carcinoma","volume":"33","author":"Young LS","year":"2014","journal-title":"Chin J Cancer"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032260"},{"issue":"12","key":"e_1_2_9_7_1","first-page":"598","article-title":"Plasma Epstein\u2010Barr virus DNA as a biomarker for nasopharyngeal carcinoma","volume":"33","author":"Chan KCA","year":"2014","journal-title":"Chin J Cancer"},{"issue":"21","key":"e_1_2_9_8_1","first-page":"5452","article-title":"Quantitative and temporal correlation between circulating cell\u2010free Epstein\u2010Barr virus DNA and tumor recurrence in nasopharyngeal carcinoma","volume":"59","author":"Lo YMD","year":"1999","journal-title":"Cancer Res"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-5816-9"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2020.100937"},{"key":"e_1_2_9_11_1","unstructured":"Roche Diagnostics GmbH. 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