Epstein‐Barr virus associated post‐transplant lymphoproliferative disorders (EBV PTLD) are recognized as a significant cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). The number of patients at risk of developing EBV PTLD is increasing, partly as a result of highly immunosuppressive regimens, including the use of anti‐thymocyte globulin (ATG). Importantly, there is heterogeneity in PTLD management strategies between alloHSCT centers worldwide. This review summarizes the different EBV PTLD prevention strategies being utilized including the alloHSCT and T‐cell depletion regimes and the risk they confer; monitoring programs, including the timing and analytes used for EBV virus detection, as well as pre‐emptive thresholds and therapy with rituximab. In the absence of an institution‐specific policy, it is suggested that the optimal pre‐emptive strategy in HSCT recipients with T‐cell depleting treatments, acute graft vs host disease (GVHD) and a mismatched donor for PTLD prevention is (a) monitoring of EBV DNA post‐transplant weekly using plasma or WB as analyte and (b) pre‐emptively reducing immune suppression (if possible) at an EBV DNA threshold of >1000 copies/mL (plasma or WB), and treating with rituximab at a threshold of >1000 copies/mL (plasma) or >5000 copies/mL (WB). There is emerging evidence for prophylactic rituximab as a feasible and safe strategy for PTLD, particularly if pre‐emptive monitoring is problematic. Future management strategies such as prophylactic EBV specific CTLs have shown promising results and as this procedure becomes less expensive and more accessible, it may become the strategy of choice for EBV PTLD prevention.

中文翻译：

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Epstein-Barr 病毒相关的移植后淋巴增殖性疾病预防策略在同种异体造血干细胞移植中。

Epstein-Barr 病毒相关的移植后淋巴组织增生性疾病（EBV PTLD）被认为是异基因造血干细胞移植（alloHSCT）患者发病率和死亡率的重要原因。有发展为 EBV PTLD 风险的患者数量正在增加，部分原因是高度免疫抑制方案，包括使用抗胸腺细胞球蛋白 (ATG)。重要的是，全球 alloHSCT 中心之间的 PTLD 管理策略存在异质性。本综述总结了正在使用的不同 EBV PTLD 预防策略，包括 alloHSCT 和 T 细胞耗竭方案及其赋予的风险；监测程序，包括用于 EBV 病毒检测的时间和分析物，以及先发制人的阈值和利妥昔单抗治疗。在缺乏机构特定政策的情况下，建议在接受 T 细胞耗竭治疗、急性移植物抗宿主病 (GVHD) 和错配供体以预防 PTLD 的 HSCT 受者中，最佳的先发制人策略是 (a) 监测EBV DNA 移植后每周使用血浆或 WB 作为分析物和 (b) 在 EBV DNA 阈值 >1000 拷贝/mL（血浆或 WB）时先发制人地减少免疫抑制（如果可能），并在>1000 拷贝/mL（血浆）或 >5000 拷贝/mL（WB）的阈值。越来越多的证据表明，预防性利妥昔单抗是一种可行且安全的 PTLD 策略，尤其是在预先监测存在问题的情况下。未来的管理策略，例如预防性 EBV 特定的 CTL，已显示出有希望的结果，并且随着该程序变得更便宜且更容易获得，