CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Finsencentret, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK.
J Cancer Res Clin Oncol. 2018 Aug;144(8):1569-1580. doi: 10.1007/s00432-018-2674-9. Epub 2018 May 26.
Emerging EBV DNAemia in plasma is considered an early sign of post-transplant lymphoproliferative disorder (PTLD). The aim of this study was to quantify the extent of benefit from screening for EBV DNAemia to detect emerging PTLD among solid organ (SOT) or hematopoietic stem cell transplant recipients (HSCT).
We used receiver operating characteristic (ROC) curves for assessing ability of models to predict PTLD. Among 2642 recipients transplanted between January 2004 and December 2014, 79 (3%) developed PTLD.
EBV DNAemia was observed in 331/1784 recipients (18.6%, 95% CI 16.8-20.4) with measured EBV DNA. The area under the curve (AUC) of the ROC of EBV DNAemia to identify persons with subsequent PTLD was 72% (95% CI, 64-79%) among SOT and 59% (51-68%) among HSCT. Including clinical predictors such as age, gender, transplant year and type, high-risk EBV serostatus, and routine biochemistry in addition to EBV DNAemia increased AUC to 83% (75-90%) among SOT and 84% (79-89%) among HSCT. Among HSCT, including additional factors such as T-cell-depleting treatment, acute graft vs. host disease and donor match increased AUC to 85% (78-91%).
We constructed a model to better predict PTLD compared to EBV DNA screening alone which could have clinical implications.
血浆中出现的 EBV DNA 血症被认为是移植后淋巴组织增生性疾病（PTLD）的早期征象。本研究旨在定量评估筛查 EBV DNA 血症以检测实体器官（SOT）或造血干细胞移植受者（HSCT）中出现的 PTLD 的获益程度。
我们使用接收者操作特征（ROC）曲线来评估模型预测 PTLD 的能力。在 2004 年 1 月至 2014 年 12 月期间接受移植的 2642 名受者中，有 79 名（3%）发生了 PTLD。
在 79 名发生 PTLD 的受者中，有 331 名（18.6%，95%CI 16.8-20.4）在测量 EBV DNA 时观察到 EBV DNA 血症。ROC 曲线分析 EBV DNA 血症用于识别随后发生 PTLD 的人的 AUC 为 SOT 中的 72%（95%CI，64-79%）和 HSCT 中的 59%（51-68%）。除了 EBV DNA 血症之外，将临床预测因子（如年龄、性别、移植年份和类型、高危 EBV 血清学状态以及常规生化指标）纳入模型中，可将 AUC 提高至 SOT 中的 83%（75-90%）和 HSCT 中的 84%（79-89%）。在 HSCT 中，包括 T 细胞耗竭治疗、急性移植物抗宿主病和供体匹配等额外因素，可将 AUC 提高至 85%（78-91%）。
与单独进行 EBV DNA 筛查相比，我们构建了一种更好地预测 PTLD 的模型，这可能具有临床意义。
