Dr. Yongjun Fang From Pre-Transplant Risk Prediction to Post-Transplant Stratification — A Comprehensive Management Strategy for EBV Reactivation After Pediatric HLH Transplantation
Dr. Yongjun Fang discusses risk assessment, EBV monitoring, immune reconstitution, and individualized post-transplant management.
Editor's Note: The 2nd Capital Hematology Forum and the 2026 Annual Meeting of the Capital Medical University Hematology Department opened grandly in Beijing. FOCUS Clinical Scientists were on site to bring frontline coverage, specially inviting Dr. Yongjun Fang from Children's Hospital of Nanjing University to share his in-depth insights on stratified intervention for EBV reactivation after pediatric hemophagocytic lymphohistiocytosis (HLH) transplantation, individualized approaches to immune reconstitution in post-transplant children, and preventive strategies to reduce the risk of hemophagocytosis relapse.
FOCUS Clinical Scientists: Post-transplant EBV reactivation is a high-risk adverse event in pediatric HLH. What are the stratified intervention stages in the standardized management protocol your team has developed?
Dr. Yongjun Fang: The protocol begins with regular quantitative EBV DNA load testing. For high-risk patients, monitoring continues for up to six months post-transplant, with monthly testing from month 1 to month 6; this surveillance period may be appropriately extended for very high-risk patients. Once EBV DNA positivity is detected, stratified intervention is immediately triggered. Measures include tapering or discontinuing immunosuppressive agents, administering low-dose chemotherapy, or selecting different regimens based on the EBV-infected cell lineage — B-cell or T-cell. For B-cell infection, rituximab may be used; for T-cell infection, hemophagocytosis may ensue and must be controlled promptly.
FOCUS Clinical Scientists: Immune reconstitution varies considerably among post-transplant children. How should antiviral agents, donor lymphocyte infusion (DLI), and monoclonal antibodies be tailored and combined for individual patients?
Dr. Yongjun Fang: Monoclonal antibody therapy can facilitate immune reconstitution to exert anti-tumor effects. Of course, DLI is also an important approach that can rapidly and effectively enhance the recipient's immune function, though it frequently triggers severe graft-versus-host disease (GVHD). Therefore, clinicians must carefully weigh the risks and benefits, making comprehensive judgments and individualized choices.
FOCUS Clinical Scientists: Can pre-transplant indicators predict the risk of EBV reactivation, allowing us to establish preventive protocols in advance and reduce the likelihood of post-transplant hemophagocytosis relapse?
Dr. Yongjun Fang: Absolutely. As I mentioned earlier, factors such as ABO incompatibility between donor and recipient, umbilical cord blood transplantation, and other variables can each have distinct impacts. Specifically, blood type mismatch, slower immune reconstitution, and severe pre-existing EBV infection prior to transplant — as illustrated in the cases I presented — are all high-risk factors. To address these, we first intensify surveillance; second, taper or discontinue immunosuppressants as early as possible; and third, consider donor lymphocyte infusion or administration of intravenous immunoglobulin containing EBV antibodies. All of these measures help control lymphoproliferative disorders driven by post-transplant EBV reactivation.
Expert Profile
Dr. Yongjun Fang
Children's Hospital of Nanjing University
With over 20 years of experience in pediatric hematology-oncology, Dr. Fang specializes in bone marrow transplantation, tumor multidisciplinary team (MDT) management, and basic research into the pathogenesis of childhood leukemia.