Prompt versus preemptive intervention for EBV lymphoproliferative disease.
Posttransplantation lymphoproliferative disorders (PTLDs) caused by uncontrolled expansion of Epstein-Barr virus (EBV)-infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by an increase in EBV DNA in peripheral blood mononuclear cells. We used real-time quantitative polymerase chain reaction (RQ-PCR) analysis to determine whether frequent monitoring of EBV DNA to allow preemptive treatment is truly of value in patients after HSCT. More than 1300 samples from 85 recipients were analyzed. No patient with consistently low EBV DNA levels developed PTLD. Nine patients had a single episode with a high EBV load (more than 4000 EBV copies/microg peripheral blood mononuclear cell [PBMC] DNA), and 16 patients had high EBV loads detected on 2 or more occasions. Only 8 of these developed symptoms consistent with PTLD, and all were promptly and successfully treated with EBV-specific cytotoxic T cells or CD20 monoclonal antibody. Hence, quantitative measurement of EBV DNA may best be used to enable the prompt rather than the preemptive treatment of PTLD.
Wagner
Hans-Joachim
HJ
Departments of Pediatrics and Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Cheng
Yee Chung
YC
Huls
M Helen
MH
Gee
Adrian P
AP
Kuehnle
Ingrid
I
Krance
Robert A
RA
Brenner
Malcolm K
MK
Rooney
Cliona M
CM
Heslop
Helen E
HE
D019264:Adoptive Transfer; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000502:physiology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology / Q000637:transplantation; D019562:Viral Load / Q000379:methods; D014775:Virus Activation
D004279:DNA, Viral