EBV is indeed risk factor after a transplant. It is one of the viruses they test for here, each week. Fortunately, we now have much more sensitive pcr (polymerase chain reaction) testing methodology available and they can detect minute traces of the virus DNA in blood.
EBV reactivation after transplant can cause something called PTLD (post transplant lymphoproliferative disease). It is manifested by rapid enlargement of lymph nodes, filled to the rafters with EBV infected B-cells. Until recently PTLD carried very high mortality risk. Left untreated PTLD often transformed into frank malignant lymphoma – dangerous stuff.
The therapy options are much improved for PTLD patients today. THE drug of choice is our old friend Rituxan, the master killer of B-cells. It is now the standard of care for transplant patients presenting with even the slightest hint of EBV reactivation.
As many of you may recall, Harvey had developed hypersensitivity to Rituxan and may not use it ever again. Several months ago I worried about this possible scenario, that Harvey may develop PTLD after transplant and we would have no way of treating him.
I contacted Genmab, the company that has been kind enough to grant him compassionate use access to Humax-CD20 a couple of years ago, to see if they would let him have Humax-CD20 for this instance as well. Once more, Genmab stepped up to the plate. We managed to get all the paper work done (FDA approvals, IRB (internal review board) approvals of Fairview hospital, legal agreements between the company and the doctor taking responsibility for treating Harvey – you won’t believe the amount of paper work). Sufficient Humax-CD20 is now safely stashed away here waiting for when and if Harvey ever needs it. So far his EBV viral titers have stayed below the detection limit and I hope they stay that way for ever!
]]>You are in my prayers —
Darlene Dorsey
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