Cellular immunity to Epstein-Barr virus in liver transplant recipients treated with rituximab for post-transplant lymphoproliferative disease

被引:68
作者
Savoldo, B [1 ]
Rooney, CM
Quiros- Tejeira, RE
Caldwell, Y
Wagner, HJ
Lee, T
Finegold, MJ
Dotti, G
Heslop, HE
Goss, JA
机构
[1] Texas Childrens Hosp, Baylor Coll Med, Ctr Cell & Gene Therapy, Houston, TX USA
[2] Texas Childrens Hosp, Baylor Coll Med, Dept Pediat, Houston, TX USA
[3] Texas Childrens Hosp, Baylor Coll Med, Dept Surg, Houston, TX USA
[4] Texas Childrens Hosp, Baylor Coll Med, Dept Pathol, Houston, TX USA
[5] Texas Childrens Hosp, Baylor Coll Med, Dept Med, Houston, TX USA
[6] Methodist Hosp, Houston, TX 77030 USA
关键词
EBV; liver transplant; PTLD; rituximab;
D O I
10.1111/j.1600-6143.2004.00693.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The evaluation of long-term cellular immunity to EBV in pediatric orthotopic liver transplant (OLT) recipients after treatment with the humanized anti-CD20 monoclonal antibody (Rituximab) has not yet been explored. At our institution, one child with EBV-related mononucleosis-like syndrome and five children with polymorphic-EBV-PTLD occurring 6-88 months after OLT were treated with Rituximab. Treatment was well tolerated. All children achieved complete remission. After Rituximab, B-lymphocytes were undetectable in the peripheral blood and EBV-load, monitored with real-time PCR, decreased to undetectable levels in all children from > 4000 copies/mug DNA at diagnosis. Four to eight months after Rituximab, EBV-load increased (> 4000 copies/mug DNA) in four children, and PTLD recurred in three. Their frequency of EBV-specific T-cell precursors, measured by Elispot analysis, remained lower than in healthy controls. Rituximab effectively induced regression of PTLD in OLT recipients. However, EBV-specific T-cell immunocompetence, which may be crucial for the long-term control of EBV-mediated proliferation, did not improve.
引用
收藏
页码:566 / 572
页数:7
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