Long-term outcomes in patients with persistent EBV-DNA positivity after primary Epstein-Barr virus infection and clinical implications of rituximab therapy.
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BACKGROUND: The long-term clinical outcomes of patients with persistent EBV-DNA positivity after primary EBV infection of B cells and the clinical value of rituximab in this group of patients are unknown. METHODS: We retrospectively analyzed patients with primary EBV-infected B cells at our center from October 2016 to July 2023. They were divided into two groups based on the presence of infectious mononucleosis. To assess disease transformation under long-term EBV exposure and the impact of rituximab on EBV-DNA clearance, we followed up and monitored the EBV-DNA changes in the conventional observation treatment subgroup and the rituximab subgroup. RESULTS: Seventy-one patients were included in this study, and 29 of them exhibited sustained EBV-DNA positivity for over 3 months. Among them, 20 patients were classified as infectious mononucleosis (IM) group, while 9 patients belonged to the non-infectious mononucleosis (NIM) group. In the IM group, 5 out of 7 patients treated with rituximab (71.4 %) became EBV-DNA negative within one month post-treatment, while 6 of the 13 patients (46.2 %) who did not undergo rituximab treatment still remained EBV-DNA positive for over 18 months. These results suggested that rituximab treatment significantly shortened the duration required for EBV-DNA clearance. In the NIM group, 5 of the 6 patients received rituximab had EBV-associated lymphoid tissue proliferation before treatment, which occurred approximately 7 months after EBV infection was detected. Following treatment, EBV-DNA became negative in all five patients within a median of 2 months. Conversely, the three patients who did not receive rituximab treatment in the NIM group, the longest duration of EBV-DNA positivity was 16 months. Disease progression or transformation was not observed in either group of patients. CONCLUSION: Patients with primary EBV infection of B cells are unlikely to progress to malignant disease transformation despite persistent EBV-DNA positivity. Nonetheless, there is a potential risk of chronic lymphoproliferation. Rituximab treatment is a safe and efficient method for eliminating EBV-infected B cells and achieving rapid clearance of EBV-DNA.