Allogeneic hematopoietic stem cell transplantation(allo-HSCT) is an effective measure for the treatment of hematological disease. With the progress and widespread use of allo-HSCT, Epstein-Barr virus(EBV) related central nervous system(CNS) diseases have gotten more and more attention because of its poor prognosis and overall survival. Since currently there is no standard treatment for patients with EBV-associated CNS diseases and reported therapies are heterogeneous with mixed results, we attempted to develop a novel therapeutic method. We have applied a regimen of intrathecal donor lymphocyte infusion(IDLI) in 3 patients with EBV-associated CNS diseases after allo-HSCT in addition to immunosuppressants reduction and combined antiviral therapy. All of 3 patients were responsive to this therapy: all clinical symptoms and EBV load in CSF resolved 10, 17 and 12 days after initial IDLI respectively, and magnetic resonance imaging (MRI) showed lesions of case 1 and 2 disappeared 15 and 19 days after initial IDLI respectively. Even more appealing, there were no acute or chronic adverse reactions during the infusion and up to 23 months of follow-up. In conclusion, IDLI seems to be an effective and safe method for EBV-associated CNS diseases in allo-HSCT recipients. We recommend this treatment modality for further investigation.

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Disclosures

No relevant conflicts of interest to declare.

Topics:
allogeneic hematopoietic stem cell transplant, central nervous system dysfunction, donor leukocyte infusion, herpesvirus 4, human, allopurinol, hematopoietic stem cell transplantation, magnetic resonance imaging, adverse effects, antiviral agents, colony-stimulating factors

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© 2018 by The American Society of Hematology
2018
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