Imperial College London


Faculty of MedicineDepartment of Brain Sciences

Professor of Practice (Neurology)







12L12CLab BlockCharing Cross Campus






BibTex format

author = {Mehra, V and Rhone, E and Widya, S and Zuckerman, M and Potter, V and Raj, K and Kulasekararaj, A and McLornan, D and de, Lavallade H and Benson-Quarm, N and Lim, C and Ware, S and Sudhanva, M and Malik, O and Nicholas, R and Muraro, PA and Marsh, J and Mufti, GJ and Silber, E and Pagliuca, A and Kazmi, MA},
doi = {cid/ciz047},
journal = {Clinical Infectious Diseases},
pages = {1757--1763},
title = {Epstein-barr virus and monoclonal gammopathy of clinical significance in autologous stem cell transplantation for multiple sclerosis.},
url = {},
volume = {69},
year = {2019}

RIS format (EndNote, RefMan)

AB - INTRODUCTION: Autologous hematopoietic stem cell transplantation (AHSCT) with anti-thymocyte globulin (ATG) conditioning as treatment of active multiple sclerosis (MS) is rapidly increasing across Europe (EBMT registry data 2017). Clinically significant Epstein-Barr virus reactivation (EBV-R) following AHSCT with ATG for severe autoimmune conditions is an underrecognized complication relative to T-cell deplete transplants performed for hematological diseases. This retrospective study reports EBV-R associated significant clinical sequelae in MS patients undergoing AHSCT with rabbit ATG. METHODS: Retrospective data were analyzed for 36 consecutive MS-AHSCT patients at Kings College Hospital, London. All patients routinely underwent weekly EBV DNA polymerase chain reaction monitoring and serum electrophoresis for monoclonal gammopathy (MG or M-protein). EBV-R with rising Epstein-Barr viral load, M-protein, and associated clinical sequelae were captured from clinical records. RESULTS: All patients had evidence of rising EBV DNA-emia, including 7 who were lost to long-term follow-up, with a number of them developing high EBV viral load and associated lymphoproliferative disorder (LPD). Nearly 72% (n = 18/29) developed de novo MG, some with significant neurological consequences with high M-protein and EBV-R. Six patients required anti-CD20 therapy (rituximab) with complete resolution of EBV related symptoms. Receiver operating characteristics estimated a peak EBV viremia of >500 000 DNA copies/mL correlated with high sensitivity (85.5%) and specificity (82.5%) (area under the curve: 0.87; P = .004) in predicting EBV-R related significant clinical events. CONCLUSION: Symptomatic EBV reactivation increases risk of neurological sequelae and LPD in MS-AHSCT. We recommend regular monitoring for EBV and serum electrophoresis for MG in MS patients in the first 3 months post-AHSCT.
AU - Mehra,V
AU - Rhone,E
AU - Widya,S
AU - Zuckerman,M
AU - Potter,V
AU - Raj,K
AU - Kulasekararaj,A
AU - McLornan,D
AU - de,Lavallade H
AU - Benson-Quarm,N
AU - Lim,C
AU - Ware,S
AU - Sudhanva,M
AU - Malik,O
AU - Nicholas,R
AU - Muraro,PA
AU - Marsh,J
AU - Mufti,GJ
AU - Silber,E
AU - Pagliuca,A
AU - Kazmi,MA
DO - cid/ciz047
EP - 1763
PY - 2019///
SN - 1058-4838
SP - 1757
TI - Epstein-barr virus and monoclonal gammopathy of clinical significance in autologous stem cell transplantation for multiple sclerosis.
T2 - Clinical Infectious Diseases
UR -
UR -
UR -
UR -
VL - 69
ER -