Ocheni S, Kroeger N, Zabelina T, Sobottka I, Ayuk F, Wolschke C, Muth A, Lellek H, Petersen L, Erttmann R, Kabisch H, Zander A R, Bacher U
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Bone Marrow Transplant. 2008 Aug;42(3):181-6. doi: 10.1038/bmt.2008.150. Epub 2008 Jun 2.
Fatal problems encountered in allogeneic stem cell transplantation include EBV reactivation and post transplant lymphoproliferative disorders (PTLDs) with high mortality rates. We performed a retrospective analysis in all consecutive adult and pediatric EBV reactivations and PTLD during a period of 8.5 years. There were 26 patients with EBV reactivation/PTLD out of a total of 854 transplantations giving an overall incidence of 3.0%. Specifically, the incidence of EBV-PTLD was 1.3%, whereas that of EBV reactivation was 1.8%. Median age was 46.0 and 11.0 years in the adult and pediatric patients, respectively. There were high rates (54%) of concomitant bacterial, viral, fungal and parasitic infections at the time of EBV manifestation. Variable treatment regimens were applied including in most cases an anti-CD20 regimen often in combination with virustatic compounds, polychemotherapy or donor lymphocytes. The mortality rates were 9 of 11 (82%) in patients with EBV-PTLD and 10 of 15 (67%) in patients with reactivation. Only 7 of 26 patients (27%) are alive after a median follow-up of 758 days (range 24-2751). The high mortality rates of EBV reactivation and of EBV-PTLD irrespective of multimodal treatment approaches emphasize standardization and optimization of post transplant surveillance and treatment strategies to improve control of these often fatal complications.
异基因干细胞移植中遇到的致命问题包括EB病毒再激活和移植后淋巴细胞增殖性疾病（PTLD），其死亡率很高。我们对8.5年间所有连续的成人和儿童EB病毒再激活及PTLD病例进行了回顾性分析。在总共854例移植中，有26例发生EB病毒再激活/PTLD，总发生率为3.0%。具体而言，EBV-PTLD的发生率为1.3%，而EB病毒再激活的发生率为1.8%。成人和儿童患者的中位年龄分别为46.0岁和11.0岁。在EB病毒表现时，同时发生细菌、病毒、真菌和寄生虫感染的比例很高（54%）。采用了多种治疗方案，在大多数情况下包括抗CD20方案，通常与抗病毒化合物、多药化疗或供体淋巴细胞联合使用。EBV-PTLD患者的死亡率为11例中的9例（82%），再激活患者的死亡率为15例中的10例（67%）。在中位随访758天（范围24 - 2751天）后，26例患者中只有7例（27%）存活。无论采用多模式治疗方法，EB病毒再激活和EBV-PTLD的高死亡率都强调了移植后监测和治疗策略的标准化和优化，以改善对这些往往致命的并发症的控制。
