title: The clinical value of concomitant Epstein Barr virus (EBV)-DNA load and specific immune reconstitution monitoring after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Monitoring of EBV DNAemia after allogeneic hematopoietic stem cell transplantation (HSCT) is necessary, but not sufficient, to identify patients at risk of EBV-induced post-transplantation lymphoproliferative disorders (PTLD). Combining this with quantifying EBV-specific cellular immunity was shown to be helpful. In this study, we evaluated the value of IFNγ-Elispot assay in monitoring EBV DNAemia after HSCT.
  
  
  METHODS
  EBV-DNA load in whole blood was monitored at least weekly using real-time PCR in 40 recipients of HSCT. Quantitative and qualitative T-cell recoveries, including EBV-specific T-cell quantification by Elispot assay, were studied 60, 100, 180 and 360 days after HSCT.
  
  
  RESULTS
  Among the 35 evaluable patients, 14 (35%) presented EBV DNAemia, only 2/14 (14%) needing pre-emptive treatment with rituximab. The greatest risk factor for EBV DNAemia was the presence of anti-thymocyte globulin (ATG) (p=0.005). EBV-specific cellular immune recovery was monitored by IFNγ-Elispot assay. Using multivariate analysis, four factors were found to significantly influence IFNγ-Elispot results at defined times post-HSCT: EBV DNAemia, young age, global T-cell recovery and severe acute GVHD. In those cases where EBV DNAemia occurred and cleared spontaneously, Elispot results gave more than 1000 spot-forming cells (SFC)/10(6)PBMC.
  
  
  CONCLUSIONS
  Elispot assay may be usefully combined with EBV-DNA load monitoring to determine when a patient should receive pre-emptive treatment, or when the clinician should avoid Rituximab use which severely immunocompromises patients.
authors: CHU de Nancy, Unité de Thérapie cellulaire et Tissus, Vandoeuvre-lès-Nancy, F54511, France.
authors: Maud
authors: M
authors: D'Aveni
authors: Lamia
authors: L
authors: Aïssi-Rothé
authors: Véronique
authors: V
authors: Venard
authors: Alexandra
authors: A
authors: Salmon
authors: Aude
authors: A
authors: Falenga
authors: Véronique
authors: V
authors: Decot
authors: Jean Marc
authors: JM
authors: Virion
authors: Yingying
authors: Y
authors: Wang
authors: Laurence
authors: L
authors: Clement
authors: Véronique
authors: V
authors: Latger-Cannard
authors: Cécile
authors: C
authors: Tomowiak
authors: Jean François
authors: JF
authors: Stoltz
authors: Pierre
authors: P
authors: Bordigoni
authors: Danièle
authors: D
authors: Bensoussan
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000956:Antigens, Viral / Q000276:immunology; D002478:Cells, Cultured; D004279:DNA, Viral / Q000032:analysis*; D058501:Enzyme-Linked Immunospot Assay; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000502:physiology*; D007111:Immunity, Cellular / Q000187:drug effects; D016867:Immunocompromised Host; D007371:Interferon-gamma / Q000378:metabolism; D008232:Lymphoproliferative Disorders / Q000235:genetics* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D015166:Monitoring, Immunologic / Q000379:methods; D015203:Reproducibility of Results; D000069283:Rituximab; D014184:Transplantation, Homologous; D019562:Viral Load / Q000187:drug effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000956:Antigens, Viral; D004279:DNA, Viral; D000069283:Rituximab; D007371:Interferon-gamma