Martin P J, Shulman H M, Schubach W H, Hansen J A, Fefer A, Miller G, Thomas E D
Ann Intern Med. 1984 Sep;101(3):310-5. doi: 10.7326/0003-4819-101-3-310.
Two patients with acute leukemia were treated with chemoradiotherapy and allogeneic bone marrow transplantation. Despite the prophylactic use of methotrexate after grafting, both patients developed severe graft-versus-host disease that was refractory to treatment with methylprednisolone. The graft-versus-host disease was then treated with a monoclonal antibody, 64.1, that reacts with a p19 antigen on human T cells. The disease responded dramatically to this treatment, but both patients subsequently developed a fatal polyclonal lymphoproliferative disorder arising in donor-derived B cells. Hybridization studies showed Epstein-Barr virus in both tumors. The combined effect of severe end-stage graft-versus-host disease and potent immunosuppressive therapy probably resulted in a progressive immunodeficiency syndrome that abrogated the T-cell-mediated surveillance mechanism that normally modulates the proliferation of Epstein-Barr-virus-infected B lymphocytes.
两名急性白血病患者接受了放化疗和异基因骨髓移植治疗。尽管移植后预防性使用了甲氨蝶呤，但两名患者均发生了严重的移植物抗宿主病，对甲基泼尼松龙治疗无效。然后用一种与人类T细胞上的p19抗原发生反应的单克隆抗体64.1治疗移植物抗宿主病。该疾病对这种治疗反应显著，但两名患者随后均发生了源自供体B细胞的致命性多克隆淋巴细胞增殖性疾病。杂交研究显示两个肿瘤中均存在EB病毒。严重的终末期移植物抗宿主病和强效免疫抑制治疗的联合作用可能导致了一种进行性免疫缺陷综合征，该综合征废除了通常调节EB病毒感染的B淋巴细胞增殖的T细胞介导的监测机制。
