This retrospective study evaluated 75 patients with chronic active Epstein–Barr virus infection (CAEBV) to compare the efficacy and survival outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) and programmed death-1 (PD-1) blockade therapy. Patients were classified into HSCT and non-HSCT groups. The primary endpoints were overall response rate (ORR), overall survival (OS), and event-free survival (EFS). HSCT significantly improved ORR, 3-year OS, and 3-year EFS compared to non-HSCT treatment. Subgroup analysis showed that PD-1 blockade achieved outcomes comparable to HSCT in a subset of patients; however, HSCT remained superior, overall, particularly in patients without hemophagocytic lymphohistiocytosis (HLH). The presence of HLH was identified as an independent risk factor for inferior survival. In conclusion, allogeneic HSCT remains the preferred curative strategy for CAEBV, whereas PD-1 blockade represents a promising alternative for carefully selected patients. Early recognition and management of HLH are crucial for improving prognosis.
Ming et al. (Fri,) studied this question.
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