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Treatment for Epstein-Barr virus should be tailored at diagnosis
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Treatment strategies for children with Epstein–Barr virus may be tailored according to individual laboratory findings at diagnosis, according to study results.
“Despite several advances in the treatment of Epstein–Barr virus (EBV) in recent years, patients with EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH) do not always show satisfactory outcomes,” the researchers wrote.
To improve the management and the outcomes in this patient population, researchers conducted a nationwide survey in Japan to identify prognostic factors of EBV-HLH in 98 children aged younger than 18 years. Patients were diagnosed between January 2003 and June 2008.
Mean age of EBV-HLH onset was 3.9 years. The most common symptoms were fever, hepatosplenomegaly, hemophagocytosis of bone marrow and lymphadenopathy.
T-cell clonality was found in 62% of the cohort, and 97% tested positive for EBV in either T- or natural killer cells.
Patients with hyperbilirubinemia (>1.8 mg/dl) and hyperferritinemia (>20,300 ng/ml) at the time of diagnosis experienced significantly worse outcomes compared with those who had low serum bilirubin and ferritin levels.
Sixty-percent of patients were treated with a multi-agent chemotherapeutic regimen. After that treatment, 90.3% of patients achieved remission and 8.2% experienced recurrence.
Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.
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