Measuring the benefits of treatment for psychosis: validity and responsiveness of the EQ-5D

BACKGROUND: The UK National Institute for Health and Clinical Excellence (NICE) has recommended that cost-effectiveness analysis includes the EQ-5D; however, this is often not implemented in the area of mental health. AIMS: To assess the appropriateness of using the EQ-5D to measure improvements in mental health. METHOD: Seventy-seven participants with psychosis were rated according to the EQ-5D and seven measures of mental health at both pre- and post-intervention. To assess construct validity we compared the (pre-intervention) mean EQ-5D scores for those with milder and more severe scores, according to each of the seven measures. To assess responsiveness we estimated the mean EQ-5D change score for those who improved (post-intervention), according to each of the measures. RESULTS: The mean EQ-5D score was more favourable for both those with milder scores (mean difference: 0.044 to 0.301) and for those who improved post-intervention (mean change: 0.029 to 0.117). CONCLUSIONS: This suggests the EQ-5D should be considered for use in future cost-effectiveness studies in the area of mental health

Memory B cell reconstitution following allogeneic haematopoietic stem cell transplantation is an EBV-associated transformation event

Allogeneic stem cell transplantation (allo-HSCT) provides a unique opportunity to track Epstein-Barr virus (EBV) infection in the context of the reconstituting B-cell system. Although many allo-HSCT recipients maintain low or undetectable levels of EBV DNA posttransplant, a significant proportion exhibit elevated and rapidly increasing EBV loads which, if left untreated, may lead to potentially fatal EBV-associated posttransplant lymphoproliferative disease. Intriguingly, this high-level EBV reactivation typically arises in the first 3 months posttransplant, at a time when the peripheral blood contains low numbers of CD27(+) memory cells which are the site of EBV persistence in healthy immunocompetent donors. To investigate this apparent paradox, we prospectively monitored EBV levels and B-cell reconstitution in a cohort of allo-HSCT patients for up to 12 months posttransplant. In patients with low or undetectable levels of EBV, the circulating B-cell pool consisted predominantly of transitional and naive cells, with a marked deficiency of CD27(+) memory cells which lasted >12 months. However, among patients with high EBV loads, there was a significant increase in both the proportion and number of CD27(+) memory B cells. Analysis of sorted CD27(+) memory B cells from these patients revealed that this population was preferentially infected with EBV, expressed EBV latent transcripts associated with B-cell growth transformation, had a plasmablastic phenotype, and frequently expressed the proliferation marker Ki-67. These findings suggest that high-level EBV reactivation following allo-HSCT may drive the expansion of latently infected CD27(+) B lymphoblasts in the peripheral blood

Memory B-cell reconstitution following allogeneic hematopoietic stem cell transplantation is an EBV-associated transformation event

Allogeneic stem cell transplantation (allo-HSCT) provides a unique opportunity to track Epstein-Barr virus (EBV) infection in the context of the reconstituting B cell system. While many allo-HSCT recipients maintain low or undetectable levels of EBV DNA post-transplant, a significant proportion exhibit elevated and rapidly increasing EBV loads which, if left untreated, may lead to potentially fatal EBV-associated post-transplant lymphoproliferative disease. Intriguingly this high level EBV reactivation typically arises in the first three months post-transplant, at a time when the peripheral blood contains low numbers of CD27(+) memory cells which are the site of EBV persistence in healthy immunocompetent donors. To investigate this apparent paradox, we prospectively monitored EBV levels and B cell reconstitution in a cohort of allo-HSCT patients for up to 12 months post-transplant. In patients with low or undetectable levels of EBV, the circulating B cell pool consisted predominantly of transitional and naïve cells, with a marked deficiency of CD27(+) memory cells which lasted more than twelve months. However, amongst patients with high EBV loads, there was a significant increase in both the proportion and number of CD27(+) memory B cells. Analysis of sorted CD27(+) memory B cells from these patients revealed that this population was preferentially infected with EBV, expressed EBV latent transcripts associated with B cell growth transformation, had a plasmablastic phenotype and frequently expressed the proliferation marker Ki-67. These findings suggest that high level EBV reactivation following allo-HSCT may drive the expansion of latently infected CD27(+) B lymphoblasts in the peripheral blood.</p