Epstein-Barr Virus-specific T-Cell Therapy for Epstein-Barr Virus-Associated Lymphoproliferative Disease after Allogeneic Hematopoietic Stem Cell Transplantation
谈辰欢 1蔡唤唤 1任星煜 1何叶成 1陈尚 1钱崇升2
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作者信息
1. 苏州卫生职业技术学院,江苏 苏州 215000
2. 苏州大学附属第一医院,江苏 苏州 215006
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摘要
目前异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)是治疗恶性血液病的有效方法,感染是allo-HSCT后的常见并发症之一,其中难治性的病毒感染仍然是allo-HSCT后免疫缺陷期发病和死亡的主要原因.EB病毒(Epstein-Barr virus,EBV)属于人疱疹病毒,也是首先被证明和人肿瘤相关的病毒,其最常见的感染方式为潜伏型,90%以上的人群都感染过EBV.EBV可潜伏在B淋巴细胞中,在移植后免疫功能低下的情况下被重新激活,引起EBV血症、EBV疾病及EBV相关的移植后淋巴细胞增殖性疾病(EBV-posttransplant lymphoproliferative disorders,EBV-PTLD).目前推荐CD20单抗作为移植后治疗EBV-PTLD的一线药物,但仍有部分患者会出现复发难治.EBV特异性T细胞(EBV specific T-cell,EBV-VST)过继免疫治疗不仅可以直接对EBV感染的B细胞产生细胞毒性作用,而且可以加快特异性抗EBV的免疫重建,从根本上预防或治疗EBV感染相关疾病.该文综述了EBV-VST治疗allo-HSCT后EBV感染相关疾病的研究,为EBV-VST过继免疫治疗的临床应用提供思路.
Abstract
Currently,allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective treatment for malignant hematological diseases.Infection is one of the common complications after allo-HSCT,refractory viral infections remain the main causes of morbidity and mortality during the immunodeficient period following allo-HSCT.Epstein-Barr Virus(EBV)belongs to the human herpesvirus family and was one of the first viruses proven to be associated with human tumors.Its most common form of infection is latent,more than 90%of the population have been infected with EBV.EBV can latency in B lymphocytes and be reactivated under conditions of impaired immune function after transplantation,leading to EBV viremia,EBV disease,and EBV post-transplant lymphoproliferative disorders(EBV-PTLD).Currently,CD20 monoclonal antibody is recommended as the first-line treatment for EBV-PTLD,but some patients may still experience recurrence and become refractory.EBV-specific T cell(EBV-VST)adoptive immunotherapy can not only directly produce cytotoxic effects on EBV-infected B cells but also accelerate the reconstruction of specific anti-EBV immunity,fundamentally preventing or treating diseases related to EBV infection.This article reviews the research on EBV-VST treatment for diseases related to EBV infection after allo-HSCT,providing insights for the clinical application of EBV-VST adoptive immunotherapy.
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