{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:33:58Z","timestamp":1792092838213,"version":"4.4.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Epstein\u2013Barr virus (EBV) reactivation represents a frequent condition after allogeneic hematopoietic stem cell transplantation (allo-HCT) and can cause the development of a severe complication: post-transplant lymphoproliferative disease (PTLD). This retrospective study aims at investigating the incidence of EBV reactivations and analyzing the potential impact of recipient\/donor-related transplant-related factors in pediatric patients. The secondary objective was to study the consequences of the approach used at our center regarding the initiation of pre-emptive therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study used a retrospective evaluation of patients aged \u226425 years who received an allo-HCT at IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Giannina Gaslini, between 2012 and 2022, with follow-up censored in July 2023. Criteria to start rituximab were as follows: a viral load \u226520,000 copies\/10<jats:sup>5<\/jats:sup> PBMCs or \u226510,000\/10<jats:sup>5<\/jats:sup> PBMCs associated with a rise in the proportion of CD 20+ lymphocytes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 214 allo-HCTs were performed in 189 patients. A total of 127 (59.3%) procedures were complicated by at least one EBV reactivation, but in only one rituximab was administered. All other reactivations were characterized by viremia below reference ranges and no increase in CD20+ lymphocytes, without clinical consequences. Risk factors for EBV reactivation identified were associated with delayed immune reconstitution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results could suggest the effectiveness of the approach used in providing pre-emptive therapy. The strategy adopted differs from that highlighted by other studies and allowed the reduction of the number of children who received rituximab. It has proven effective considering the low incidence rate of PTLD and reduces the risk of rituximab-related adverse events.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2024.1492367","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T04:31:33Z","timestamp":1729830693000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Epstein\u2013Barr virus reactivation in pediatric allogeneic stem cell transplant recipients: an 11-year experience on viral load and B lymphocyte monitoring strategy"],"prefix":"10.3389","volume":"15","author":[{"given":"Giulia","family":"Ferrando","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Bagnasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filomena","family":"Pierri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pestarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Dell\u2019Orso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Giardino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddi","family":"Di Marco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Santaniello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Castagnola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Faraci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2009.302","article-title":"Viral-load and B-lymphocyte monitoring of EBV reactivation after allogeneic hemopoietic SCT in children","volume":"45","author":"Faraci","year":"2010","journal-title":"Bone Marrow Transplant"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.144428","article-title":"Management of epstein-barr virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: Sixth European conference on infections in leukemia (ECIL-6) guidelines","volume":"101","author":"Styczynski","year":"2016","journal-title":"Haematologica"},{"key":"B3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/petr.13519","article-title":"Hypogammaglobulinemia and bacterial infections following pediatric post-transplant lymphoproliferative disorder in the rituximab era","volume":"23","author":"Chiou","year":"2019","journal-title":"Pediatr Transplant"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/hon.v24:4","article-title":"Bronchiolitis obliterans with organizing pneumonia after rituximab therapy for non-Hodgkin\u2019s lymphoma","volume":"24","author":"Biehn","year":"2006","journal-title":"Hematol Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s13045-022-01284-6","article-title":"Worked to the bone: antibody-based conditioning as the future of transplant biology","volume":"15","author":"Griffin","year":"2022","journal-title":"J Hematol Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/petr.13519","article-title":"Rituximab for posttransplant lymphoproliferative disorder \u2013 therapeutic, preemptive, or prophylactic","volume":"59","author":"Storek","year":"2024","journal-title":"Bone Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1427637","article-title":"Impact of prophylaxis with rituximab on EBV-related complications after allogeneic hematopoietic cell transplantation in children","volume":"15","author":"Marja\u0144ska","year":"2024","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1590\/0037-8682-0036-2014","article-title":"Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients","volume":"47","author":"Marques HH de","year":"2014","journal-title":"Rev da Sociedade Bras Medicina Tropical"},{"key":"B9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1371\/journal.pone.0228451","article-title":"Viral reactivations following hematopoietic stem cell transplantation in pediatric patients - A single center 11-year analysis","volume":"15","author":"D\u00fcver","year":"2020","journal-title":"PloS One"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181e7a3bf","article-title":"Incidence and dynamics of epstein-barr virus reactivation after alemtuzumab-based conditioning for allogeneic hematopoietic stem-cell transplantation","volume":"90","author":"Carpenter","year":"2010","journal-title":"Transplantation"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.087338","article-title":"Risk factors for Epstein-Barr virus-related post-transplant lymphoproliferative disease after allogeneic hematopoietic stem cell transplantation","volume":"99","author":"Uhlin","year":"2014","journal-title":"Haematologica"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1492367\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T04:31:34Z","timestamp":1729830694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1492367\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,25]]},"references-count":11,"alternative-id":["10.3389\/fimmu.2024.1492367"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2024.1492367","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,25]]},"article-number":"1492367"}}