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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3979-3981.
Prepublished online as a Blood First Edition Paper on January 29, 2004; DOI 10.1182/blood-2003-12-4287.
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TRANSPLANTATION
Brief report
Prompt versus preemptive intervention for EBV lymphoproliferative disease
Hans-Joachim Wagner,
Yee Chung Cheng,
M. Helen Huls,
Adrian P. Gee,
Ingrid Kuehnle,
Robert A. Krance,
Malcolm K. Brenner,
Cliona M. Rooney, and
Helen E. Heslop
From the Center for Cell and Gene Therapy and the Departments of Pediatrics and Medicine, Baylor College of Medicine, Houston; the Methodist Hospital, Houston; and Texas Children's Hospital, Houston, TX.
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/µg 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.
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