title: Advances in the diagnosis and treatment of EBV-associated lymphoproliferative diseases in immunocompromised hosts.
abstract: The clinical, immunopathologic, and virologic features of the lymphoproliferative diseases occurring after renal transplantation have been characterized. Clinically, patients may present with an infectious mononucleosis-like illness or with localized solid tumor masses. These lymphoproliferative diseases have unique histologic features that can be classified as polymorphic diffuse B-cell hyperplasia (PDBH) or polymorphic B-cell lymphoma (PBL). Immunologic cell-typing studies have shown that the majority are polyclonal B-cell proliferations, but monoclonal B-cell tumors have also been documented. These B-cell proliferations may, however, evolve from a benign polyclonal B-cell hyperplasia to a monoclonal malignant lymphoma. The Epstein-Barr virus (EBV) has been implicated as the cause of these disorders. Serologic studies frequently demonstrate evidence of a primary or reactivation infection, touch imprints from involved tissue may stain for the presence of EBNA (Epstein-Barr nuclear antigen), and EBV DNA hybridization studies demonstrate the presence of EBV-specific DNA sequences within tumor cells. Since EBV induces a polyclonal B-cell proliferation in vitro and in vivo, the polyclonality of these diseases also implicates EBV. Acyclovir, a new synthetic antiviral agent that inhibits EBV DNA replication may be effective in some patients during the polyclonal growth phase but is ineffective once the tumor evolves into a monoclonal lymphoma. We have identified several factors that may be useful in predicting responsiveness to acyclovir therapy.
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000957:Antigens, Viral, Tumor / Q000032:analysis; D001402:B-Lymphocytes / Q000473:pathology; D002471:Cell Transformation, Neoplastic; D004247:DNA / Q000235:genetics; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D006965:Hyperplasia; D016030:Kidney Transplantation; D008223:Lymphoma / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D009693:Nucleic Acid Hybridization; D014181:Transplantation Immunology
chemical_list: D000957:Antigens, Viral, Tumor; D004247:DNA; D000212:Acyclovir