Treatment of severe Epstein-Barr virus-induced polyclonal B-lymphocyte proliferation by anti-B-cell monoclonal antibodies. Two cases after HLA-mismatched bone marrow transplantation.
We treated two children who developed Epstein-Barr virus-induced polyclonal B-cell proliferation after HLA-mismatched bone marrow transplantation for congenital immunodeficiency with two monoclonal anti-B-cell antibodies. Lymphoproliferative syndrome occurred between 50 and 60 days after bone marrow infusion, and was diagnosed by the presence of spontaneously growing B cells containing Epstein-Barr-nuclear antigen in the blood and bone marrow. The mouse monoclonal anti-B-cell antibodies used were a CD21-specific antibody recognizing the CR2 receptor on B cells (BL13, IgG1) and a CD24-specific antibody binding B cells at all steps of differentiation (ALB9 IgG1). Both antibodies were given intravenously (0.2 mg/kg/body weight.d for 10 days). All clinical and biological manifestations resolved within 3 weeks of treatment. Recurrence was not seen at 18- and 15-month follow-ups. T-cell function developed normally; B-cell function remained partially deficient in one patient 21 months after bone marrow transplantation. These results suggest that monoclonal anti-B-cell antibodies could be useful in controlling severe polyclonal lymphoproliferative syndrome in profoundly immunodeficient patients after bone marrow transplantation.
Blanche
S
S
Unité d'Immunologie and Hématologie, Hôpital Necker-Enfants Malades, Paris, France.
Le Deist
F
F
Veber
F
F
Lenoir
G
G
Fischer
A M
AM
Brochier
J
J
Boucheix
C
C
Delaage
M
M
Griscelli
C
C
Fischer
A
A
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000956:Antigens, Viral / Q000032:analysis; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology*; D016026:Bone Marrow Transplantation; D036022:Capsid Proteins; D002455:Cell Division; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens / Q000032:analysis*; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D008297:Male; D011947:Receptors, Antigen, B-Cell / Q000032:analysis; D014184:Transplantation, Homologous / Q000009:adverse effects
D000911:Antibodies, Monoclonal; D000956:Antigens, Viral; D036022:Capsid Proteins; C041788:Epstein-Barr viral capsid antigen; C033305:Epstein-Barr virus early antigen; D006680:HLA Antigens; D011947:Receptors, Antigen, B-Cell