Treatment of posttransplant lymphoproliferative disease in the central nervous system of a lung transplant recipient using allogeneic leukocytes
Treatment of posttransplant lymphoproliferative disease in the central nervous system of a lung transplant recipient using allogeneic leukocytes
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DOI：
10.1097/00007890-199706150-00027
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发表时间：
1997-06-15
期刊：
影响因子：
6.2
通讯作者：
Smith, FO
中科院分区：
文献类型：
--
作者：
Emanuel, DJ;Lucas, KG;Smith, FO
移植后 Epstein-Barr 病毒相关淋巴增殖性疾病 (PT-LPD) 是实体器官和造血干细胞移植后常见且往往致命的并发症。实体器官移植后的 PT-LPD 通常发生在受者来源的 B 细胞中，而骨髓移植受者中的 PT-LPD 完全来自供体来源。最近报道了使用供体白细胞的过继免疫疗法治疗骨髓移植受者的 PT-LPD 的疗效。由于实体器官移植受者中的 PT-LPD 通常是受者来源，因此实体器官受者中 PT-LPD 过继免疫疗法的潜在应用必须使用自体或同种异体 HLA 相同白细胞，如果使用与移植器官不匹配的细胞，则会带来器官排斥的风险。来自 EB 病毒 (EBV) 血清反应阳性、HLA 相同的正常兄弟姐妹的未照射同种异体单核细胞被用于治疗一名接受过 HLA 不匹配尸体肺移植的儿童中枢神经系统受者来源的单克隆 EBV 淋巴瘤。该患者在 9 个月内接受了 3 次单独的单核细胞输注，每次输注每公斤含有 1x10(6) CD3(+) 单核细胞。通过该治疗方案实现了临床、放射学和病理学的完全缓解。该反应与正常 EBV 特异性细胞毒活性和细胞毒 T 淋巴细胞前体频率的体内重建相关。因此，使用同种异体 HLA 相容性单核细胞可能为传统疗法难治的选定实体器官移植受者的 EBV 相关淋巴增殖性疾病提供另一种治疗模式。
Posttransplant Epstein-Barr virus-related lymphoproliferative disease (PT-LPD) is a common and often fatal complication following solid organ and hematopoietic stem cell transplantation. PT-LPD following solid organ transplantation generally occurs in B cells of recipient origin in contrast to PT-LPD in marrow transplant recipients, which is exclusively of donor origin. The efficacy of adoptive immunotherapy using donor leukocytes to treat PT-LPD in bone marrow transplant recipients has recently been reported. Because PT-LPD in solid organ transplant recipients is generally of recipient origin, the potential application of adoptive immunotherapy of PT-LPD in solid organ recipients obligates the use of either autologous or allogeneic HLA identical leukocytes, with the attendant risk of organ rejection if cells mismatched with the transplanted organ are used. Nonirradiated allogeneic mononuclear cells from an Epstein-Barr virus (EBV)-seropositive, HLA-identical normal sibling were used to treat a monoclonal EBV lymphoma of recipient origin in the central nervous system of a child who had undergone an HLA-mismatched cadaveric lung transplant. The patient received three separate mononuclear cell infusions over a 9-month period, each containing 1x10(6) CD3(+) mononuclear cells per kilogram. Complete clinical, radiological, and pathological remission was achieved with this treatent regimen. The response correlated with in vivo reconstitution of normal EBV-specific cytotoxic activity and cytotoxic T lymphocyte precursor frequency. Use of allogeneic HLA-compatible mononuclear cells may thus offer an additional mode of therapy for EBV-related lymphoproliferative disease in selected solid organ transplant recipients refractory to conventional therapies.