Immunoblastic lymphoma of donor origin in the allograft after lung transplantation.
Posttransplant lymphoproliferative disorders (PTLD) are EBV-associated lymphoid neoplasms that are caused by the uncontrolled growth of EBV-infected B lymphocytes. The clinical presentation of PTLD can range from benign polygonal lymphoproliferative disorders to aggressive monoclonal immunoblastic lymphomas. In this report, we describe a seronegative lung transplant recipient who developed an immunoblastic lymphoma 4 months after lung transplantation from a seropositive donor. The neoplastic cells expressed B lymphocyte markers (CD19+, CD20+, sIgM+, kappa+) as well as the EBV antigen EBNA-2. A cell line with similar cytologic features spontaneously grew from in vitro cultures of the patient's peripheral blood mononuclear cells. The cell line and the lymphoma were EBV+, expressed a similar spectrum of B cell surface proteins, and had the donor's HLA haplotype. Analysis of immunoglobulin gene rearrangements and viral terminal repeat sequences revealed that the cell line and the tumor represented distinct B cell clones. Cultured peripheral blood mononuclear cells were restimulated in vitro with the EBV transformed cell line and tested for cytolytic activity. The host T cells demonstrated high levels of cytolytic activity against the tumor cell line that was abrogated by the addition of a anti-monomorphic HLA class I monoclonal antibody (mAb) (W6/32). These studies indicate that cells of donor origin can persist in the transplanted organ and may lead to an EBV-associated posttransplant lymphoma.
Mentzer
S J
SJ
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Longtine
J
J
Fingeroth
J
J
Reilly
J J
JJ
DeCamp
M M
MM
O'Donnell
W
W
Swanson
S J
SJ
Faller
D V
DV
Sugarbaker
D J
DJ
D000911:Antibodies, Monoclonal / Q000494:pharmacology; D001402:B-Lymphocytes / Q000473:pathology; D002472:Cell Transformation, Viral; D002478:Cells, Cultured; D004279:DNA, Viral / Q000032:analysis; D006239:Haplotypes; D004854:Herpesvirus 4, Human / Q000235:genetics; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008213:Lymphocyte Activation; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000209:etiology* / Q000276:immunology* / Q000473:pathology; D010641:Phenotype; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D014407:Tumor Cells, Cultured
D000911:Antibodies, Monoclonal; D004279:DNA, Viral; D015395:Histocompatibility Antigens Class I