Monitoring of EBV-DNA load in patient 3.
A 10-year-old boy with T-cell ALL received a TCD bone marrow graft from a mismatched unrelated donor. The early posttransplant course was uncomplicated. Intravenous infusions of foscarnet were given during the entire observation period because of detection of CMV-DNA in leukocytes and leukopenia. The majority of circulating T cells were of recipient origin during the first 3 months after BMT, whereas B cells, macrophages, and granulocytes were of donor origin as determined by PCR. Donor T cells were infused on days +62 and +82, and only donor T cells were detected in the circulation 6 months after BMT. Two infusions of 107/m2 EBV-CTLs were given on day +148 and +160. There were no clinical signs of GVHD after T-cell infusions or EBV-CTL treatment. Cyclosporin A was discontinued 9 months after BMT. The T-cell leukemia relapsed 16 months after BMT, with a lethal outcome.
