血浆EB病毒DNA载量监测对单倍体造血干细胞移植后淋巴细胞增殖性疾病的预测价值

OBJECTIVE: To determine the optimal cutoff value of Epstein-Barr virus（EBV）DNA load that can assist in the diagnosis of post-transplant lymphoproliferative disease（PTLD）after haploidentical hematopoietic stem cell transplantation（haplo-HSCT）. METHODS: The data of patients with EBV infection after haplo-HSCT from January to December 2016 were retrospectively analyzed. Through constructing the receiver operating characteristic（ROC）curve and calculating the Youden index to determine the cutoff value of EBV-DNA load and its duration of diagnostic significance for PTLD. RESULTS: A total of 94 patients were included, of whom 20（21.3％）developed PTLD, with a median onset time of 56（40–309）d after transplantation. The median EBV value at the time of diagnosis of PTLD was 70,400（1,710–1,370,000）copies/ml, and the median duration of EBV viremia was 23.5（4–490）d. Binary logistic regression was used to analyze the peak EBV-DNA load（the EBV-DNA load at the time of diagnosis in the PTLD group）and duration of EBV viremia between the PTLD and non-PTLD groups. The results showed that the difference between the two groups was statistically significant（P＝0.018 and P＝0.001）. The ROC curve was constructed to calculate the Youden index, and it was concluded that the EBV-DNA load ≥ 41 850 copies/ml after allogeneic hematopoietic stem cell transplantation had diagnostic significance for PTLD（AUC＝0.847）, and the sensitivity and specificity were 0.611 and 0.932, respectively. The duration of EBV viremia of ≥20.5 d had diagnostic significance for PTLD（AUC＝0.833）, with a sensitivity and specificity of 0.778 and 0.795, respectively. CONCLUSION: Dynamic monitoring of EBV load in high-risk patients with PTLD after haplo-HSCT and attention to its duration have important clinical significance, which can help clinically predict the occurrence of PTLD in advance and take early intervention measures.