Objective: To analyze the detection rate, clinical significance, and prognosis of Epstein-Barr virus (EBV) in the cerebrospinal fluid (CSF) of patients following allogeneic hematopoietic stem cell transplantation. Methods: A retrospective analysis was performed on 1100 patients who underwent the CSF virus test after allogeneic hematopoietic stem cell transplantation in Peking University People's Hospital between January 2017 and June 2022. Among them, 19 patients were screened positive for EBV in their CSF, and their clinical characteristics, treatment, and prognosis were analyzed. Results: Among 19 patients with EBV-positive cerebrospinal fluid, 12 were male and 7 were female, with 5 patients aged <18 years and 12 aged ≥18 years, with a median age of 27 (5-58) years old. There were 7 cases of acute myeloid leukemia, 8 of acute lymphocytic leukemia, 2 of aplastic anemia, 1 of Hodgkin's lymphoma, and 1 of hemophagocytic syndrome. All 19 patients underwent haploid hematopoietic stem cell transplantation, including 1 secondary transplant. Nineteen patients had neurological symptoms (headache, dizziness, convulsions, or seizures), of which 13 had fever. Ten cases showed no abnormalities in cranial imaging examination. Among the 19 patients, 6 were diagnosed with EB virus-related central nervous system diseases, with a median diagnosis time of 50 (22-363) days after transplantation. In 9 (47.3%) patients, EBV was detected in their peripheral blood, and they were treated with intravenous infusion of rituximab (including two patients who underwent lumbar puncture and intrathecal injection of rituximab). After treatment, EBV was not detected in seven patients. Among the 19 patients, 2 died from EBV infection and 2 from other causes. Conclusion: In patients who exhibited central nervous system symptoms after allogeneic hematopoietic stem cell transplantation, EBV should be screened as a potential pathogen. EBV detected in the CSF may indicate an infection; however, it does not confirm the diagnosis.
目的： 分析异基因造血干细胞移植患者脑脊液EB病毒检出情况及其临床意义。 方法： 2017年1月至2022年6月，1100例在北京大学人民医院接受异基因造血干细胞移植的血液病患者因出现中枢神经系统症状送检脑脊液病毒检测，其中19例脑脊液EB病毒检测阳性，回顾性分析其临床特征、治疗及预后。 结果： 19例脑脊液EB病毒阳性患者中男12例，女7例，年龄<18岁5例，≥18岁12例，中位年龄27（5~58）岁。急性髓系白血病7例，急性淋巴细胞白血病8例，再生障碍性贫血2例，霍奇金淋巴瘤1例，噬血细胞综合征1例。全部19例患者均为单倍体造血干细胞移植，其中二次移植1例。19例患者均有神经系统症状（头痛、头晕、抽搐或癫痫发作），其中13例患者伴发热。10例头颅影像学检查未见异常。19例患者中6例诊断为EB病毒相关中枢神经系统疾病，中位诊断时间为移植后50（22~363）d。9例（47.3%）患者外周血EB病毒检测阳性，均予以利妥昔单抗静脉滴注治疗（其中2例患者行腰椎穿刺鞘内注射给药），治疗后7例患者血EB病毒转为阴性。19例患者中2例复发，2例死于EB病毒感染，2例死于其他原因。 结论： 异基因造血干细胞移植患者出现中枢神经系统症状时，应进行EB病毒检测；脑脊液EB病毒检测阳性提示存在EB病毒感染，但不能作为确诊依据。.
Keywords: Epstein-Barr virus; Hematopoietic stem cell transplantation; cerebrospinal fluid (CSF).