Tsai Donald E, Nearey Monica, Hardy Christine L, Tomaszewski John E, Kotloff Robert M, Grossman Robert A, Olthoff Kim M, Stadtmauer Edward A, Porter David L, Schuster Stephen J, Luger Selina M, Hodinka Richard L
Hematologic Malignancies Program, University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania 19104, USA.
Am J Transplant. 2002 Nov;2(10):946-54. doi: 10.1034/j.1600-6143.2002.21011.x.
Epstein-Barr virus (EBV) is known to be involved in the majority of patients who develop post-transplant lymphoproliferative disorder after solid organ transplant. We conducted a retrospective study to determine the utility of qualitative and quantitative Epstein-Barr virus polymerase chain reaction (PCR) for the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients. Peripheral blood leukocytes obtained from 35 adult solid organ transplant patients consecutively referred for evaluation of possible post-transplant lymphoproliferative disorder, were tested by EBV PCR at the time of initial evaluation and at time points thereafter. Eighteen of 35 (51%) patients were ultimately diagnosed with post-transplant lymphoproliferative disorder by tissue biopsy. Fifteen of 18 (83%) patients were found to have EBER-1 positive tumors by in situ hybridization. EBV PCR was positive in 7 of 15 patients, suggesting a sensitivity of 39%. Seventeen patients without post-transplant lymphoproliferative disorder and three with EBER-1 negative post-transplant lymphoproliferative disorder all had negative EBV PCR tests, suggesting a specificity of 100%. We observed that declines in EBV DNA load were associated with response to therapeutic interventions, such as reduction in immunosuppression, rituximab therapy and chemotherapy. We conclude that peripheral blood EBV PCR may have a role in the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients.
已知爱泼斯坦-巴尔病毒（EBV）与大多数实体器官移植后发生移植后淋巴细胞增殖性疾病的患者有关。我们进行了一项回顾性研究，以确定定性和定量爱泼斯坦-巴尔病毒聚合酶链反应（PCR）在诊断和监测成年实体器官移植患者移植后淋巴细胞增殖性疾病中的效用。对连续转诊以评估可能的移植后淋巴细胞增殖性疾病的35例成年实体器官移植患者在初次评估时及之后的时间点采集的外周血白细胞进行EBV PCR检测。35例患者中有18例（51%）最终通过组织活检被诊断为移植后淋巴细胞增殖性疾病。18例患者中有15例（83%）通过原位杂交发现EBER-1阳性肿瘤。15例患者中有7例EBV PCR呈阳性，敏感性为39%。17例未发生移植后淋巴细胞增殖性疾病的患者和3例EBER-1阴性的移植后淋巴细胞增殖性疾病患者的EBV PCR检测均为阴性，特异性为100%。我们观察到EBV DNA载量的下降与治疗干预的反应相关，如免疫抑制的减少、利妥昔单抗治疗和化疗。我们得出结论，外周血EBV PCR可能在成年实体器官移植患者移植后淋巴细胞增殖性疾病的诊断和监测中发挥作用。
