Epstein-Barr virus (EBV) contributes to diverse malignancies defined by distinct patterns of viral latent antigen expression, which shape tumor immunogenicity and influence responsiveness to T-cell therapies. Adoptive transfer of EBV-specific T cells (EBVSTs) has demonstrated exceptional efficacy in posttransplant lymphoproliferative disease (PTLD), particularly after hematopoietic stem cell transplantation (HSCT), when donor-derived EBVSTs restore antiviral immunity, persist long term, and induce high response rates with minimal toxicity. Advances in manufacturing and the development of multispecific virus-specific T cells (VSTs) have increased accessibility, while “off-the-shelf” third-party products now enable urgent treatment and have achieved regulatory approval in Europe. Type 2 latency tumors such as Hodgkin lymphoma, non-Hodgkin lymphoma, and nasopharyngeal carcinoma remain more challenging due to restricted antigen expression and immunosuppressive tumor microenvironments. Strategies that enrich T cells targeting the type 2 latency antigens, LMP1, LMP2, EBNA1, and BARF1 have improved outcomes, but many patients require enhanced approaches to overcome tumor immune evasion. Genetic engineering technologies—resistance to immunosuppressive drugs, providing cytokine support, dominant-negative TGFβ receptors, chemokine receptors, and chimeric antigen receptors—offer promising avenues to improve persistence, trafficking, and antitumor potency. Collectively, the clinical experience underscores the safety, durability, and therapeutic potential of EBVSTs across EBV-associated diseases. Continued innovation in engineering and antigen targeting is poised to broaden VST applicability and support development of widely available cell therapies for EBV-associated and other cancers.