title: Anti-B cell antibodies for the treatment of monoclonal Epstein-Barr virus-induced lymphoproliferative syndrome after multivisceral transplantation.
abstract: Epstein-Barr virus-induced lymphoproliferative syndrome (EBV-LPS) is associated with OKT3 therapy in transplant patients. Response to chemotherapy or radiation is generally poor, while polyclonal EBV-LPS has had favorable responses to therapy with CD21 and CD24 monoclonal antibodies. Oligoclonal disease has not been previously reported to respond to therapy with CD21 and CD24. We report a 27-y old woman who developed a monoclonal EBV-LPS (confirmed by southern analysis of tumour for EBV DNA) after 180 mg of OKT3 for a multivisceral transplant. The patient achieved clinical remission for more than 2 months, but later died from cytomegalovirus pneumonia. Levels of CD21 and CD24 were > 2000 ng/ml during therapy and no human anti-mouse antibodies were formed. Peripheral blood B cells were cleared during therapy. We conclude that CD21 and CD24 monoclonal antibodies may be of value in the therapy of oigoclonal EBV-LPS, and merit further study.
authors.affiliation: University Hospital, London, Ontario.
authors.forename: A I
authors.initials: AI
authors.lastname: Lazarovits
authors.forename: L A
authors.initials: LA
authors.lastname: Tibbles
authors.forename: D R
authors.initials: DR
authors.lastname: Grant
authors.forename: C N
authors.initials: CN
authors.lastname: Ghent
authors.forename: W J
authors.initials: WJ
authors.lastname: Wall
authors.forename: M J
authors.initials: MJ
authors.lastname: White
authors.forename: J H
authors.initials: JH
authors.lastname: Joncas
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000276:immunology*; D005260:Female; D006566:Herpesviridae Infections / Q000188:drug therapy*; D004854:Herpesvirus 4, Human; D006801:Humans; D007165:Immunosuppression Therapy; D007421:Intestine, Small / Q000637:transplantation; D016031:Liver Transplantation; D016393:Lymphoma, B-Cell / Q000150:complications; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000821:virology*; D016377:Organ Transplantation / Q000009:adverse effects*; D016035:Pancreas Transplantation; D013270:Stomach / Q000637:transplantation
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum