Imperial College London
Alternate

ProfessorRichardNicholas

Faculty of Medicine, Department of Brain Sciences

Professor of Practice (Neurology)
 
 
 
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r.nicholas

 
 
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Location

 

12L12CLab BlockCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mehra:2019:cid/ciz047,
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 = {http://dx.doi.org/10.1093/cid/ciz047},
volume = {69},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
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  - http://dx.doi.org/10.1093/cid/ciz047
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30980715
UR  - https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz047/5455218
UR  - http://hdl.handle.net/10044/1/71829
VL  - 69
ER  -
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