Meijer E, Slaper-Cortenbach I C M, Thijsen S F T, Dekker A W, Verdonck L F
Department of Hematology, University Medical Centre, Utrecht, The Netherlands.
Bone Marrow Transplant. 2002 Feb;29(4):335-9. doi: 10.1038/sj.bmt.1703362.
Here, the influence of T vs T and B cell depletion on the incidence of EBV-associated lymphoproliferative disorder (EBV-LPD) after bone marrow transplantation (BMT) from a matched unrelated donor (MUD) is analyzed. From 1982 to 1997 the soy bean agglutinin/sheep red blood cell (SBA/SRBC) method was used for T cell depletion. This technique is well established, but the use of SRBC has a risk of transmitting prions or viruses. Therefore, a new T cell depletion method was introduced, using CD2 and CD3 monoclonal antibodies (CD2/3 method) instead of SRBC. Unfortunately, this led to an unexpected high number of EBV-LPDs in patients receiving transplants from MUDs. SBA depletion was reintroduced and combined with the CD2/3 method (SBA/CD2/3) in this patient population, later replaced by B cell-specific (CD19 and CD22) antibodies (CD3/19/22 method). The number of T (x 10(5)/kg) and B (x 10(5)/kg) cells in the graft was 1.5 +/- 0.8 and 2 +/- 1 (T/B ratio 0.75), 2.2 +/- 2.0 and 41 +/- 21 (ratio 0.055), 5.0 +/- 0.0 and 2 +/- 1 (ratio 2.5), 2.5 +/- 1.2 and 10 +/- 6 (ratio 0.25) using the SBA/SRBC, CD2/3, SBA/CD2/3 and CD3/19/22 techniques, respectively. When B cell depletion was performed (SBA/SRBC, SBA/CD2/3, CD3/19/22) four out of 31 patients (13%) receiving a BMT from a MUD developed an EBV-LPD. Without B cell depletion (CD2/3) this occurred in five out of seven patients (71%) (P < 0.05). A T/B cell ratio in the graft of > or = 0.25 seems sufficient to significantly reduce the incidence of EBV-LPD after BMT from MUDs.
在此，分析了T细胞与T和B细胞清除对来自匹配无关供体（MUD）的骨髓移植（BMT）后EB病毒相关淋巴增殖性疾病（EBV-LPD）发生率的影响。1982年至1997年期间，采用大豆凝集素/绵羊红细胞（SBA/SRBC）方法进行T细胞清除。该技术已得到充分确立，但使用SRBC存在传播朊病毒或病毒的风险。因此，引入了一种新的T细胞清除方法，使用CD2和CD3单克隆抗体（CD2/3方法）代替SRBC。不幸的是，这导致接受MUD移植的患者中EBV-LPD的数量意外增加。在该患者群体中重新引入了SBA清除并与CD2/3方法（SBA/CD2/3）联合使用，后来又被B细胞特异性（CD19和CD22）抗体（CD3/19/22方法）所取代。使用SBA/SRBC、CD2/3、SBA/CD2/3和CD3/19/22技术时，移植物中T（×10⁵/kg）细胞和B（×10⁵/kg）细胞的数量分别为1.5±0.8和2±1（T/B比值0.75）、2.2±2.0和41±21（比值0.055）、5.0±0.0和2±1（比值2.5）、2.5±1.2和10±6（比值0.25）。当进行B细胞清除时（SBA/SRBC、SBA/CD2/3、CD3/19/22），31例接受MUD骨髓移植的患者中有4例（13%）发生了EBV-LPD。未进行B细胞清除时（CD2/3），7例患者中有5例（71%）发生了EBV-LPD（P<0.05）。移植物中T/B细胞比值≥0.25似乎足以显著降低MUD骨髓移植后EBV-LPD的发生率。
