Epstein Barr virus (
EBV)-associated lymphoproliferative
diseases (LPDs) express all
EBV latent
antigens (type III latency) in immunodeficient
patients and limited
antigens (type I and II latencies) in immunocompetent
patients. Post-
transplantation lymphoproliferative
disease (PTLD) is the prototype exhibiting type III
EBV latency. Although
EBV antigens are highly immunogenic, PTLD
cell proliferation remains unchecked because of the underlying
immunosuppression. The restoration of anti-
EBV immunity by
EBV-specific
T cells of either autologous or allogeneic origin has been shown to be safe and effective in PTLDs. Cellular
therapy can be improved by establishing a bank of
human leukocyte antigen-characterized allogeneic
EBV-specific
T cells. In
EBV+ LPDs exhibiting type I and II latencies, the use of
EBV-specific
T cells is more limited, although the
safety and
efficacy of this
therapy have also been demonstrated. The
therapeutic role of
EBV-specific
T cells in
EBV+ LPDs
needs to be critically reappraised with the advent of
monoclonal antibodies and other targeted
therapy. Another strategy involves the use of
epigenetic approaches to induce
EBV to undergo lytic proliferation when expression of the viral
thymidine kinase renders host
tumor cells susceptible to the cytotoxic effects of
ganciclovir. Finally, the prophylactic use of
antiviral drugs to prevent
EBV reactivation may decrease the occurrence of
EBV+ LPDs.