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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.
Submitted December 22, 2003
Accepted January 13, 2004
Prompt versus Pre-emptive Intervention For EBV- Lymphoproliferative Disease
Hans-Joachim Wagner, Yee Chung Cheng, Mary H Huls, Adrian P Gee, Ingrid Kuehnle, Robert A Krance, Malcolm K Brenner, Cliona M Rooney, and Helen E Heslop*
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; The Methodist Hospital, Houston, TX, USA
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; The Methodist Hospital, Houston, TX, USA
* Corresponding author; email: hheslop{at}bcm.tmc.edu.
Post-transplant lymphoproliferative disorders (PTLD) due to uncontrolled expansion of Epstein-Barr virus (EBV) infected B cells after hematopoietic stem cell transplantation (HSCT) can be predicted by a rise in EBV DNA in peripheral blood mononuclear cells. We have used real-time quantitative PCR analysis to discover if frequent monitoring of EBV DNA to allow pre-emptive 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 developed PTLD. Nine patients had a single episode with a high EBV load (>4000 EBV-copies/µg PBMC DNA) and sixteen patients had a high EBV load detected on two or more occasions. Only 8 of these developed symptoms consistent with PTLD and 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 pre-emptive treatment of PTLD.
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