[HTML][HTML] Dissecting Epstein-Barr virus-specific T-cell responses after allogeneic EBV-specific T-cell transfer for central nervous system posttransplant …

RE Schultze-Florey, S Tischer, L Kuhlmann… - Frontiers in …, 2018 - frontiersin.org
RE Schultze-Florey, S Tischer, L Kuhlmann, P Hundsdoerfer, A Koch, I Anagnostopoulos
Frontiers in Immunology, 2018frontiersin.org
Epstein–Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD) with
central nervous system (CNS) involvement is a severe complication after solid organ
transplantation. Standard treatment with reduction of immunosuppression and anti-CD20
antibody application often fails leading to poor outcome. Here, we report the case of an 11-
year-old boy with multilocular EBV-positive CNS PTLD 10 years after liver transplantation.
Complete remission was achieved by repeated intravenous and intrathecal anti-CD20 …
Epstein–Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD) with central nervous system (CNS) involvement is a severe complication after solid organ transplantation. Standard treatment with reduction of immunosuppression and anti-CD20 antibody application often fails leading to poor outcome. Here, we report the case of an 11-year-old boy with multilocular EBV-positive CNS PTLD 10 years after liver transplantation. Complete remission was achieved by repeated intravenous and intrathecal anti-CD20 antibody rituximab administration combined with intrathecal chemotherapy (methotrexate, cytarabine, prednisone) over a time period of 3 months. Due to the poor prognosis of CNS PTLD and lack of EBV-specific T-cells (EBV-CTLs) in patient’s blood, we decided to perform EBV-directed T-cell immunotherapy as a consolidating treatment. The patient received five infusions of allogeneic EBV-CTLs from a 5/10 HLA-matched unrelated third-party donor. No relevant acute toxicity was observed. EBV-CTLs became detectable after first injection and increased during the treatment course. Next-generation sequencing (NGS) TCR-profiling verified the persistence and expansion of donor-derived EBV-specific clones. After two transfers, epitope spreading to unrelated EBV antigens occurred suggesting onset of endogenous T-cell production, which was supported by detection of recipient-derived clones in NGS TCR-profiling. Continuous complete remission was confirmed 27 months after initial diagnosis.
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