EB病毒特异细胞毒T淋巴细胞治疗造血干细胞移植术后伴急性移植物抗宿主病的EBV感染的临床分析  

Clinical Analysis of Treating EBV Infection Accompanied with GVHD after Allon-HSCT by EBV-Specific Cytotoxic T Lymphocytes

作　　者：王静波[1] 袁磊 程昊钰 费新红 顾江英 薛松 贺俊宝 张维婕 WANG Jing-Bo;YUAN Lei;CHENG Hao-Yu;FEI Xin-Hong;GU Jiang-Ying;XUE Song;HE Jun-Bao;ZHANG Wei-Jie(Department of Hematology,Aerospace Center Hospital,Beijing,100049,China)

机构地区：[1]北京大学航天中心医院血液科,北京100049

出　　处：《中国实验血液学杂志》2018年第5期1515-1522,共8页Journal of Experimental Hematology

摘　　要：目的:研究EBV特异杀伤T淋巴细胞(EBV-CTL)治疗造血干细胞移植术后合并急性移植物抗宿主病的EBV感染的疗效和安全性。方法:回顾性分析北京大学航天中心医院血液科2015年1月至2017年5月31日接受EBV-CTL输注治疗异基因造血干细胞移植后EBV感染12例的临床特征,疗效和安全性指标。结果:12例移植后接受EBV-CTL治疗的病例中,9例未接受利妥昔单克隆抗体治疗,4例发展为移植后淋巴细胞增殖性疾病(PTLD)(含3例使用利妥昔单克隆抗体病例)。出现EBV感染中位时间47(22-71)d,CTL输注前抗病毒治疗中位时间10(8-33)d,开始CTL治疗中位时间为移植后59(34-86)d。43例次细胞输注过程顺利,无相关不良事件发生,未见原有GVHD加重。第1疗程结束后9例获得CR,1例获得PR,2例获得NR,治疗后复发4例。第2疗程结束时复发4例均获得再次CR,PR病例最终仍未获得CR,移植后5个月死于GVHD。2例NR中仅1例获得CR,另1例仍处于NR,移植后5个月死于移植相关感染。4例PTLD病例均获得PTLD治愈。结论:初步结果显示,异基因造血干细胞移植术后合并急性移植物抗宿主病的EBV感染接受EBV-CTL治疗具有较好的安全性,但是其疗效仍需要进一步临床深入研究和证实。Objective:To investigate the efficiency and safety of treating Epstein-Barr virus(EBV)infection of acute graft versus host disease(GVHD)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)by EBV specific cytotoxic T lymphocytes(EBV-CTL).Methods:The Clinical characteristics,therapeutic efficacy and safety of 12 patients with EBV infection treated by EBV-CTL infusion after allo-HSCT in Department of Hemahlogy of Aero Space Center Hospital between Jan 2015 and May 2017 were analyzed retrospectioely.Results:Our of 12 cases received EBVCTL infusion after transplantation,9 did not received Rituximab therapy due to the active infection,4 cases including 3 received Ritaximab progressed into posttransplantation lymphoroliferetive disease(PTLD).The median time of EBV infection was 47(22-71)days,median time of antivirus therapy before tramplantation was 10(8-33)days,median time of first CTL infusion was 59(34-86)days after transplatation.The 43 cases-time CTL infusion was performed smoothly,no related harmful evnts occoured,no progression of GVHD was observed.After the first course of infusion,complete remission(CR),Partial remssion(PR)and no remssion(NR)were obtained in 9,1 and 2 patients respectively,the relapse was observed in 4 patients who then received the socond course of infusion and all reached CR,the patient in PR did not reathed CR finally and died of GVGD at 5 months after transpplantation.Only 1 out of 2 cases of NR obtained CR,another 1 still was in NR,and died of transplantation related infection at 5 months after transplantation.4 cases of PTLD were all cared.Conclusion:Preliminary results of this study suggest that EBV-CTL infusion is safe for the EBV infection combined with acute GVHD after all-HSCT.However,a further larger scale clinical studies are needed to prove the efficiency.

关 键 词：EB病毒感染 细胞毒T淋巴细胞 造血干细胞移植 急性移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学] R333.11[医药卫生—临床医学]