[Lymphoproliferative syndromes associated with Epstein-Barr virus in transplantation].
We report 23 cases of lymphoproliferative diseases which occurred among 2,100 patients with kidney or combined kidney+pancreas transplant. Eleven patients developed a severe diffuse disease within the first 3 months post-transplantation; immunoblastic B cells of recipient origin infiltrated the bone-marrow, transplanted organs, liver, spleen, lymph nodes, lungs, and brain; immunoglobulin abnormalities with fever, leuko-thrombocytopenia and liver dysfunction constituted the symptoms; all patients received anti-lymphocyte globulins; 9 patients were also treated with cyclosporin. Three out of 6 tumors analysed were monoclonal. Epstein-Barr virus was present in 3 lesions analysed. Treatment consisted of cessation of immunosuppressive therapy. Nine patients died with lactic acidosis. Five patients had a less severe form. Seven patients had solid tumors involving the tonsils, lungs (2), lymph nodes (2), and bladder, 8 months after transplantation. All patients received cyclosporin; 4 also received anti-lymphocyte globulins and 3 OKT3. Tumor cells were immunoblasts expressing B cells markers at a late stage of B cell differentiation; 4 tumors were monoclonal. C myc was negative. Treatment consisted of cessation of immunosuppressive therapy, antiviral agents, and monoclonal antibodies (mAb): anti-CD21 and anti-CD24 mAb therapy was followed by cure of the lymphoma in 1 patient, by transient remission in a second one and by failure in the third patient. Two patients had a recurrence of the lymphoma and received chemotherapy; 2 patients died of the lymphoma, 1 died of unrelated cause; 4 are alive, 3 of them having a good graft function.
Garnier
J L
JL
Service de Transplantation et d'Immunologie Clinique, Hôpital Ed.-Herriot, Lyon.
Touraine
J L
JL
Berger
F
F
Magaud
J P
JP
Lefrançois
N
N
Pouteil-Noble
C
C
Betuel
H
H
Martin
X
X
Dubernard
J M
JM
Lenoir
G
G
D015703:Antigens, CD / Q000032:analysis / Q000276:immunology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007108:Immune Tolerance; D016030:Kidney Transplantation / Q000009:adverse effects*; D016393:Lymphoma, B-Cell / Q000209:etiology* / Q000276:immunology; D016035:Pancreas Transplantation / Q000009:adverse effects*; D014412:Tumor Virus Infections / Q000150:complications* / Q000276:immunology / Q000382:microbiology
D015703:Antigens, CD
Syndromes lymphoprolifératifs associés au virus d'Epstein-Barr en transplantation.