The Clinical Situation And Efficacy Analysis Of EBV Infection In Children After Allo-HSCT

Part?Clinical Study of EBV Infection in Pediatric Patients after Allogeneic Hematopoietic Stem Cell TransplantationObjective:To explore the incidence and outcome of Epstein-Barrvirus(EBV)emia and EBV-related disease in pediatric patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT),investigate predictive factors for high EBVemia and EBV-related post-transplantation lymphoproliferative diseases(PTLD),and evaluate the effectiveness of the preemptive treatment with rituximab.Method:From September 2010 to January 2012,123 pediatric patients who underwent allo-HSCT with at the institute of Shanghai Children's Medical Center,and who were also monitored for EBV-DNA copies in peripheral blood cells at least once a week after the reconstitution of neutrophil,were included in this study.A positive result was considered as blood EBV-DNA copies above 1×10~3 copies/ml.Acyclovir(10 ml/kg,intravenous drip,8 h)was used for preemptive therapy and immnuo-suppressants were decreased if possible.When EBV-DNA copies in peripheral blood cells raise rapidly,rixtuximab will be used to treat the diseases.Result:The incidences of EBVemia in pediatric patients after allo-HSCT were 59.3%.Rate of EBV primary infection was 59.2%,and the rate of EBV activation was 59.4%.The incidence of EBV associated diseases was 6.8%.After antiviral and immnuo-suppressants decreased treatment,54 out of 73 patients got their peripheral blood EBV DNA negative.The antiviral treatment efficiency was76.8%.Both univariate and multivariate analysis indicated that the use of ATG was the factor for EBV viremia.Conclusions:Dynamic monitoring of EBV-DNA copies and early systematic preemptive rituximab therapy for high risk patients allowed for improving the prognosis.Part ? Clinical Study of EBV Associated Diseases in Pediatirc Patients after Allogeneic Hematopoietic Stem Cell TransplantationObjective: To explore the epidemiology,clinical characteristics,diagnosis,treatment and prognosis of EBV Related Diseases in pediatirc patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Method : From September 2010 to January 2012,73 pediatirc patients who underwent allo-HSCT at the institute of Shanghai Children's Medical Center,as well as who had a positive virus-DNA in peripheral blood cells included in this study.For all the patients who were monitored by EBV-DNA copies in peripheral blood mononuclear cells after allo-HSCT,a preemptive treatment with acyclovir was given.When EBV-DNA copies rose persistently,anti-CD20 monoclonal antibody,rituximab would be given.Once PTLD was diagnosed,abreduction or withdrawal of immunosuppression was administered.Result:The incidences of PTLD for pediatirc patients in pediatric patients with EBV viremia after allo-HSCT were 2.73%(2/73).ALl the PTLD patients were monitored by EBV-DNA copies after allo-HSCT,and both had persistent high level of EBV-DNA copies before the diagnosis of PTLD,also after the first course of rituximab..EBV-DNA copies were monitored after allo-HSCT,and both of two PTLD patients had persistent high level of EBV-DNA copies before the diagnosis of PTLD,also after the first course of rituximab.After therapies,one of PTLD patients was cured and alive till now;however,the other one had no effect to the therapy and died 34 days after the diagnosis of PTLD.Conclusions: EBV associated disease is a rare and potentially fatal complication for pediatirc patients after allo-HSCT.Dynamic monitoring of EBV-DNA copies has certain guiding on the early diagnosis and treatment for EBV associated disease.The preemptive treatment with rituximab can reduce the incidence and mortality of EBV associated disease.