INTERFERON-ALPHA AFFECTS THE IMMUNE-RESPONSE IN POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER

Post-transplant lymphoproliferative disorder (PTLD) is associated with Epstein-Barr virus (EBV) and characterized by fever, lymphadenopathy, and graft dysfunction. We describe the clinical course of an EBV sero negative 11-yr-old boy who underwent double lung transplantation and s ubsequently developed PTLD in the graft. A reduction in immunosuppress ion and the addition of acyclovir did not result in improvement. Treat ment with interferon-alpha (IFN-alpha), however, led to dramatic clini cal, radiographic, and histologic improvement. Semiquantitative measur ements of cytokine mRNA in his bronchoalveolar lavage cells prior to t herapy with IFN-alpha revealed high levels of IL-4 and IL-10 mRNA, whi ch decreased significantly with treatment. We speculate that the benef icial effect of IFN-alpha in the treatment of PTLD is directly related to the inhibition of type 2 helper (Th2-like) T-cells.