van Esser J W, van der Holt B, Meijer E, Niesters H G, Trenschel R, Thijsen S F, van Loon A M, Frassoni F, Bacigalupo A, Schaefer U W, Osterhaus A D, Gratama J W, Löwenberg B, Verdonck L F, Cornelissen J J
Department of Hematology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, The Netherlands.
Blood. 2001 Aug 15;98(4):972-8. doi: 10.1182/blood.v98.4.972.
Reactivation of the Epstein-Barr virus (EBV) after allogeneic stem cell transplantation (allo-SCT) may evoke a protective cellular immune response or may be complicated by the development of EBV-lymphoproliferative disease (EBV-LPD). So far, very little is known about the incidence, recurrence, and sequelae of EBV reactivation following allo-SCT. EBV reactivation was retrospectively monitored in 85 EBV-seropositive recipients of a T-cell--depleted (TCD) allo-SCT and 65 EBV-seropositive recipients of an unmanipulated allo-SCT. Viral reactivation (more than 50 EBV genome equivalents [gEq]/mL) was monitored frequently by quantitative real-time plasma polymerase chain reaction until day 180 after SCT. Probabilities of developing viral reactivation were high after both unmanipulated and TCD-allogeneic SCT (31% +/- 6% versus 65% +/- 7%, respectively). A high CD34(+) cell number of the graft appeared as a novel significant predictor (P =.001) for EBV reactivation. Recurrent reactivation was observed more frequently in recipients of a TCD graft, and EBV-LPD occurred only after TCD-SCT. High-risk status, TCD, and use of antithymocyte globulin were predictive for developing EBV-LPD. Plasma EBV DNA quantitatively predicted EBV-LPD. The positive and negative predictive values of a viral load of 1000 gEq/mL were, respectively, 39% and 100% after TCD. Treatment-related mortality did not differ significantly between TCD and non-TCD transplants, but the incidence of chronic graft-versus-host disease was significantly less in TCD patients. It is concluded that EBV reactivation occurs frequently after TCD and unmanipulated allo-SCT, especially in recipients of grafts with high CD34(+) cell counts. EBV-LPD, however, occurred only after TCD, and EBV load quantitatively predicted EBV-LPD in recipients of a TCD graft. (Blood. 2001;98:972-978)
异基因干细胞移植（allo - SCT）后，爱泼斯坦 - 巴尔病毒（EBV）的重新激活可能引发保护性细胞免疫反应，也可能并发EBV淋巴增殖性疾病（EBV - LPD）。到目前为止，关于allo - SCT后EBV重新激活的发生率、复发情况及后遗症，人们了解甚少。我们对85例接受T细胞去除（TCD）allo - SCT的EBV血清学阳性受者和65例接受未处理allo - SCT的EBV血清学阳性受者进行了EBV重新激活的回顾性监测。通过定量实时血浆聚合酶链反应频繁监测病毒重新激活情况（病毒载量超过50个EBV基因组当量[gEq]/mL），直至SCT后180天。未处理和TCD异基因SCT后发生病毒重新激活的概率都很高（分别为31%±6%和65%±7%）。移植物中高CD34(+)细胞数量是EBV重新激活的一个新的显著预测指标（P = 0.001）。TCD移植物受者中反复重新激活更为常见，且EBV - LPD仅在TCD - SCT后发生。高危状态、TCD以及抗胸腺细胞球蛋白的使用可预测EBV - LPD的发生。血浆EBV DNA可定量预测EBV - LPD。TCD后病毒载量为1000 gEq/mL时的阳性和阴性预测值分别为39%和100%。TCD移植与非TCD移植的治疗相关死亡率无显著差异，但TCD患者慢性移植物抗宿主病的发生率显著较低。结论是，TCD和未处理的allo - SCT后EBV重新激活频繁发生，尤其是在CD34(+)细胞计数高的移植物受者中。然而，EBV - LPD仅在TCD后发生，且EBV载量可定量预测TCD移植物受者的EBV - LPD。（《血液》。2001年；98:972 - 978）
