Immunotherapy for Infectious Diseases

Viral Infections Other than HIV 253
Table 1
Recommendations for Prophylaxis of Respiratory Syncytial Virus (RSV) Infections
in Children
Population Method of prophylaxis
�2 years old with chronic lung disease requiring
therapy in last 6 months
Palivizumab preferred
Born at �32 weeks gestational age Palivizumab preferred
Born at 32–35 weeks gestational age Palivizumab only if other underlying
condition present
�2 years old with chronic lung disease requiring RSVIG contraindicated in presence
therapy in last 6 months or born at �32 weeks of cyanotic congenital heart
gestational age with congenital heart defect defects; consider Palivizumab
Severely immunocompromised children (severe Consider RSVIG in RSV season in
combined immunodeficiency or AIDS) place of IVIG
patients treated with this adoptive cell therapy, clinical and pathologic resolution of the
EBV-associated lymphoma was observed in 20 of the 22 patients; reduction or eradication
of lymphoma cells with replacement by a T-cell infiltrate was noted as early as
8 days following infusion. Thirteen of the 22 patients treated have survived in sustained
remission for 3–42 months following lymphocyte infusion; no patient has experienced
relapse of lymphoma. Of the 22 patients from Memorial Sloan-Kettering, 3 patients
developed acute graft-versus-host disease, and 9 patients developed chronic graftversus-host
disease, which was a cause of death in 1 patient. However, the results with
regard to eradication of EBV-associated lymphoma by donor cell transfer are less consistent
at centers where T-cell-specific monoclonal antibody and pharmacologic interventions
are routine for the prevention of graft-versus-host disease (16). Such
interventions may prevent or delay an effective response by the donor-derived EBVspecific
cells.
The infusion of donor-derived EBV-specific T-cells has also been used prophylactically
to prevent immunoblastic lymphoma in children undergoing allogenic bone marrow
tranplant who were felt to be at high risk for the development of lymphoma post
transplant. No EBV-related lymphomas were diagnosed in the 39 children so treated;
additionally, in those children who had high levels of EBV-DNA detected before entry,
2–4 log decreases in EBV DNA levels were seen (17).
Alterations in the lymphoid populations of the recipients have been observed after
infusion of donor-derived PMBCs. Expansion of CD4� and CD8� populations of
T-cells are common. Lymphocyte responses to mitogens and antigens to which the
donor has been exposed also increase in the recipients (18).
A similar strategy has been applied to therapy of EBV-related lymphoma complicating
organ allograft. Emanuel and colleagues (19) have reported complete pathologic
remission of a multifocal monoclonal EBV� B-cell lymphoma of the central nervous
system complicating lung allograft. The patient received a total of three infusions of
PMBCs from his HLA-matched sibling over 8 months; biopsies done 6 weeks after the
third infusion did not demonstrate residual lymphoma (19). A variation on this approach
involves the activation of autologous PBMC with IL-2 prior to reinfusion in four