Exploring beyond viral load testing for EBV lymphoproliferation: Role of serum IL-6 and IgE assays as adjunctive tests

• Published in: Pediatric transplantation 2010-11, Vol.14 (7), p.852-858
• Main Authors: Barton, M., Wasfy, S., Hébert, D., Dipchand, A., Fecteau, A., Grant, D., Ng, V., Solomon, M., Chan, M., Read, S., Stephens, D., Tellier, R., Allen, U. D.
• Format: Article
• Language: English
• Subjects: Adolescent; Area Under Curve; Biological and medical sciences; Biomarkers - metabolism; Child; Child, Preschool; Cohort Studies; Epstein-Barr virus; Female; Herpesvirus 4, Human - metabolism; Humans; Immunoglobulin E; Immunoglobulin E - blood; Infant; Infectious diseases; Interleukin 6; Interleukin-6 - blood; iummunoglobulin E; Leukocytes, Mononuclear - cytology; Lymphocytes - metabolism; Lymphocytes - virology; Lymphoproliferative Disorders - blood; Lymphoproliferative Disorders - virology; Male; Medical sciences; Pediatrics; post-transplant lymphoproliferative disorder; posttransplant lymphoproliferative disorders; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes, Cytotoxic - cytology; Viral diseases; Viral Load
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2010.01352.x

Barton M, Wasfy S, Hébert D, Dipchand A, Fecteau A, Grant D, Ng V, Solomon M, Chan M, Read S, Stephens D, Tellier R, Allen UD and the EBV and Associated Viruses Collaborative Research Group. Exploring beyond viral load testing for EBV lymphoproliferation: Role of serum IL‐6 and IgE assays as adjunctive tests.
Pediatr Transplantation 2010: 14: 852–858. © 2010 John Wiley & Sons A/S. :  We examined serum IL‐6 and IgE assays as adjuncts to VL monitoring for PTLD. Paediatric solid organ transplant recipients were followed with VL monitoring. VL, IL‐6, and IgE assays were compared between PTLD cases and non‐cases at 6 months after transplantation. Median IL‐6 levels in PTLD cases were 15.5 (2.0–87.1) and 23.3 (2.1–276) pg/mL compared with 3.25 (0.92–114) and 3.5 (0.75–199.25) pg/mL in non‐cases at 3–6 and >6 months, respectively (p = 0.006 and p = 0.005). At >6 months, IL‐6 levels correlated with VL and PTLD occurrence (Spearman’s coefficients = 0.40; p = 0.001 and 0.32; p = 0.003) in univariate analyses. No benefit was derived from performance of IgE levels. The sensitivity and specificity of high VL as a test of PTLD were 76.3% and 92.5%, while the negative predictive value and PPV of VL were 94.9% and 68.4%, respectively. Combining elevated IL‐6 with high VL increased the PPV and specificity to 80% and 96.2%, respectively, and improved the receiver operating characteristic curve. Serum IL‐6 levels can improve the clinician’s ability to identify PTLD, among patients with elevated EBV viral loads.