Lack of virus-specific cell-mediated immunity (CMI) is associated with worse viral infection outcome in hematopoietic stem cell transplantation (HSCT). We aimed to evaluate the role of immunological monitoring of Epstein–Barr virus (EBV) infection in addition to virological one in 33 adult and 18 pediatric allogeneic HSCT recipients. Virological monitoring of infection was performed on whole blood samples by a quantitative real-time PCR assay. Immunological monitoring was performed by Enzyme-linked ImmunoSPOT assay, evaluating EBV-specific CMI, at fixed time-points and when EBV DNAemia was ≥ 10,000 copies/mL. Fifty-one percent of patients developed a post-transplant EBV infection and reduced-intensity conditioning regimen was the only factor associated to infection (P = 0.023). Lack of EBV-specific CMI during active EBV infection was associated with a greater severity of infection. Patients without EBV-specific CMI showed higher median peak level of EBV DNAemia than patients with EBV-specific CMI (P = 0.014), and consequently received more frequently, at EBV DNAemia peak, anti-CD20 therapy (0 versus 54.5%, P = 0.002). No patients with EBV-specific CMI versus 27.2% without EBV-specific CMI developed EBV-related complications (P = 0.063), including two lethal EBV-related post-transplant lymphoproliferative disorders. Combined immunological and virological measurements could improve EBV infection management in HSCT, anticipating the beginning of preemptive treatment from the EBV DNAemia peak to the finding of the lack of EBV-specific CMI.

中文翻译：

---

除病毒学监测外，在HSCT之后测量爱泼斯坦-巴尔病毒特异性细胞介导的免疫的临床效用：一项前瞻性研究的结果。

缺乏病毒特异性细胞介导的免疫（CMI）与造血干细胞移植（HSCT）中较差的病毒感染结果相关。我们的目的是评估33名成人和18名小儿同种异体HSCT接受者中除病毒学检查外，还对爱泼斯坦-巴尔病毒（EBV）感染进行免疫学监测的作用。通过定量实时PCR分析对全血样本进行病毒学感染监测。在固定的时间点以及当EBV DNAemia≥10,000拷贝/ mL时，通过酶联ImmunoSPOT分析，评估EBV特异性CMI进行免疫学监测。51％的患者发生了移植后EBV感染，而强度降低的治疗方案是与感染相关的唯一因素（P = 0.023）。主动EBV感染期间缺乏EBV特异性CMI与更大的感染严重程度相关。没有EBV特异性CMI的患者比EBV特异性CMI的患者表现出更高的EBV DNAemia峰值中位数（P  = 0.014），因此在EBV DNAemia峰值时接受抗CD20治疗的频率更高（0比54.5％，P  = 0.002）。没有EBV特异性CMI的患者中没有EBV特异性CMI的患者为27.2％（P> = 0.063），包括两种致命的EBV相关的移植后淋巴增生性疾病。结合免疫学和病毒学检测可以改善HSCT中的EBV感染管理，预计从EBV DNAemia高峰到缺乏EBV特异性CMI的发现开始抢先治疗。