Anti-B cell antibodies for the treatment of monoclonal Epstein-Barr virus-induced lymphoproliferative syndrome after multivisceral transplantation.
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.
Lazarovits
A I
AI
University Hospital, London, Ontario.
Tibbles
L A
LA
Grant
D R
DR
Ghent
C N
CN
Wall
W J
WJ
White
M J
MJ
Joncas
J H
JH
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
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum