Clinical and virological characteristics of 15 patients with chronic active Epstein-Barr virus infection treated with hematopoietic stem cell transplantation
Clinical and virological characteristics of 15 patients with chronic active Epstein-Barr virus infection treated with hematopoietic stem cell transplantation
复制标题
DOI：
10.1086/587671
复制
发表时间：
2008-05-15
影响因子：
11.8
通讯作者：
Kimura, Hiroshi
中科院分区：
文献类型：
--
作者：
Gotoh, Kensei;Ito, Yoshinori;Kimura, Hiroshi
背景。慢性活动性EB病毒（EBV）感染的特点是反复出现传染性单核细胞增多症样症状，感染患者外周血中病毒载量较高。该疾病的标准治疗方法尚未建立。最近，造血干细胞移植（HSCT）被引入，并有潜力成为标准治疗方法，尽管尚未提出HSCT治疗慢性活动性EBV感染的指南。对 15 例患者进行临床和病毒学方面的回顾性分析，探讨与 HSCT 治疗的慢性活动性 EBV 感染预后相关的因素。 HSCT后，7名患者在生存期为1至16个月（HSCT后平均生存期为5个月）后死亡。三名患者被认为死于移植相关并发症。死亡患者从感染开始到诊断之间的时间明显长于幸存者。 7 名死亡患者中有 5 名经历了≥ 3 种危及生命的并发症。干扰素-γ、白细胞介素-10、血栓调节蛋白和可溶性 E-选择素的血浆浓度在各组患者之间没有显着差异。至于 EBV 潜伏膜蛋白 1 基因的序列变异，在死亡患者中没有发现特定模式。重要的是，死亡患者诊断时的血浆 EBV 载量显着高于活着的患者。此外，血浆病毒载量被证明是 HSCT 患者随访期间监测的一个重要因素。结论。危及生命的并发症的数量和血浆病毒载量可以指示疾病进展的阶段，并且可能是预测 HSCT 结果的有用因素。
Background. Chronic active Epstein-Barr virus (EBV) infection is characterized by recurrent infectious mononucleosis-like symptoms, and infected patients have high viral loads in their peripheral blood. Standard therapy for the disease has not yet been established. Recently, hematopoietic stem cell transplantation (HSCT) has been introduced and has the potential to become a standard treatment, although guidelines for HSCT to treat chronic active EBV infection have not yet been proposed.Methods. Fifteen patients were retrospectively analyzed, both clinically and virologically, to investigate the factors associated with prognosis of chronic active EBV infection treated with HSCT.Results. After HSCT, 7 patients died after survival periods that ranged from 1 to 16 months ( mean duration of survival after HSCT, 5 months). Three patients were considered to have died of transplantation-related complications. The duration between infection onset and diagnosis was significantly longer in patients who died than in those who survived. Five of the 7 patients who died experienced >= 3 life-threatening complications. The plasma concentrations of interferon-gamma, interleukin-10, thrombomodulin, and soluble E-selectin did not differ significantly between the groups of patients. With regard to sequence variations in the EBV latent membrane protein 1 gene, no specific patterns were found in the patients who died. Importantly, the plasma EBV load at diagnosis was significantly higher in patients who died than in living patients. Moreover, plasma viral load was shown to be an important factor to monitor during follow-up for patients after HSCT.Conclusions. The number of life-threatening complications and plasma viral load are indicative of the stage of disease progression and may be useful factors for predicting the outcome of HSCT.