Retrospective evaluation of serum Epstein Barr virus DNA levels in 406 allogeneic stem cell transplant patients
Retrospective evaluation of serum Epstein Barr virus DNA levels in 406 allogeneic stem cell transplant patients
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DOI：
10.3324/haematol.10751
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发表时间：
2007-06-01
期刊：
影响因子：
10.1
通讯作者：
Ruutu, Tapani
中科院分区：
文献类型：
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作者：
Juvonen, Eeva;Aalto, Sanna;Ruutu, Tapani
背景与目的hla不匹配的供体和t细胞缺失的移植物是干细胞移植后eb病毒（EBV）再激活的已知危险因素。我们研究了接受hla相同供者未经处理的移植物移植的患者血清EBV DNA水平的频率和结果。设计与方法采用定量聚合酶链反应（PCR）对406例连续异基因干细胞移植患者5479份血清进行EBV DNA回顾性分析。结果406例患者血清中检出bv DNA 56例（14%）。接受兄弟姐妹供体移植的患者中有9%呈EBV阳性，接受无血缘关系供体移植的患者中有29%呈EBV阳性。在三分之一的病例中，EBV-PCR阳性在未经特异性治疗的情况下消退，在另外三分之一的病例中，副本数逐渐增加或在最后一份血清样本中较高，而在其余三分之一的病例中，包括最后一份样本在内的所有阳性血清中副本数均较低。在多变量分析中，任何原因给予抗胸腺细胞球蛋白和III-IV级急性移植物抗宿主病是EBV再激活的唯一具有统计学意义的危险因素。在本分析时，只有8/56例EBV-DNA阳性患者存活。EBV-PCR阳性的结果不能通过拷贝数或首次阳性样本的时间来预测。结论sebv再激活是同种异体干细胞移植受者的普遍现象。在许多患者中，病毒血症无需ebv定向治疗即可解决。严重的急性移植物抗宿主病和任何原因给予的抗胸腺细胞球蛋白是EBV病毒血症的危险因素。
Background and ObjectivesAn HLA-mismatched donor and a T-cell-depleted graft are known risk factors for Epstein-Barr virus (EBV) reactivation after stem cell transplantation. We studied the frequency and outcome of serum EBV DNA levels in patients transplanted with an unmanipulated graft from an HLA-identical donor.Design and MethodsOverall, 5479 serial serum samples from 406 consecutive allogeneic stem cell transplant recipients were analyzed retrospectively for EBV DNA with quantitative polymerase chain reaction (PCR).ResultsEBV DNA was found in the serum of 56 of the 406 patients (14%). EBV positivity was seen in 9% of the recipients of a graft from a sibling donor and in 29% of those with an unrelated donor. EBV-PCR positivity resolved without specific treatment in a third of the cases, in another third the copy number increased progressively or was high in the last serum sample, and in the remaining third the copy numbers were low in all positive sera including the last sample. In multivariate analysis antithymocyte globulin given for any reason and grade III-IV acute graft-versus-host disease were the only statistically significant risk factors for EBV reactivation. Only 8/56 patients with EBV-DNA positivity were alive at the time of the present analysis. The outcome of EBV-PCR positivity could not be predicted by the copy number or the timing of the first positive sample.Interpretation and ConclusionsEBV reactivation was a common phenomenon in allogenic stem cell transplant recipients. In many patients the viremia resolved without EBV-directed treatment. Severe acute graft-versus-host disease and antithymocyte globulin given for any reason were risk factors for EBV viremia.