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Risks of Developing Epstein-Barr Virus-Related Lymphoproliferative
Disorders After T-Cell-Depleted Marrow Transplants
Geoff Hale and
Herman Waldmann for CAMPATH Users
From the Sir William Dunn School of Pathology, University of Oxford,
Oxford, UK.
T-cell depletion of bone marrow for allogeneic transplantation is
known to increase the risks of Epstein-Barr virus-driven lymphoproliferative disorders that may result in fatal lymphoma, especially with transplants from unrelated or mismatched donors. Over
the past 15 years, we have monitored the outcome of 2,582 transplants
using CAMPATH-1 (CD52) antibodies to deplete lymphocytes from donor
and/or recipient to prevent graft-versus-host disease or
rejection. Unlike many other methods of T-cell depletion, CAMPATH-1 antibodies also deplete B lymphocytes. The actuarial risk of
lymphoproliferative disease using CAMPATH-1 for depletion of donor
lymphocytes was up to 1.3%, hardly different from reported figures for
conventional nondepleted transplants. In contrast, the risk in a small
group of patients transplanted from unrelated donors using E-rosette depletion was as high as 29%, comparable to other reports of specific T-cell depletion. We conclude that the additional depletion of B cells
is beneficial, possibly because it reduces either the virus load or the
virus target until the time when T cells begin to regenerate.
Blood, Vol. 91 No. 8 (April 15), 1998:
pp. 3079-3083
© 1998 by The American Society of Hematology.
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