• Yahong You, Jingshi Wang, and Zhao Wang.
• Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
• Medicine (Baltimore). 2022 Jan 14; 101 (2): e28542e28542.

RationaleSystemic forms of chronic active Epstein-Barr virus infection (CAEBV) can predispose a patient to a protracted course of fulminant hemophagocytic lymphohistiocytosis, which has a poor prognosis. Epstein-Barr virus (EBV) infection may persist even after theoretically curative hematopoietic stem cell transplantation.Patient ConcernsA female patient with CAEBV underwent chemotherapy followed by allogeneic hematopoietic stem cell transplantation from her human leukocyte antigen-matched sister. Neutrophil and platelet engraftment was observed on day +12 and +10. Full donor chimerism (DC) was achieved on Day +21.DiagnosesFrom day +38, EBV-DNA in the blood was persistently positive, and DC declined. We attempted empirical interventions such as withdrawal of immune suppression, multiple donor lymphocyte infusion, stem cell boost, and interferon-α treatment. However, EBV-DNA copies continued to increase aggressively, whereas DC decreased rapidly and then reached a nadir of 63.27%.InterventionsSalvage programmed death 1 (PD-1) antibody treatment was administered as salvage therapy at +69 and +84.OutcomesEBV-DNA was negative on day +97 and was ultimately undetectable. Equivalently, a full and stable DC was obtained at +97.LessonsWe summarize a case of PD-1 antibody used as salvage treatment in a post-transplant patient with CAEBV, which was eradicated and full DC was obtained. This case suggests that the PD-1 antibody appears to be a promising option for fighting EBV and mixed DCs.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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