Risk factors for developing EBV-related B cell lymphoproliferative disorders (BLPD) after non-HLA-identical BMT in children.
B cell lymphoproliferative disorders (BLPD) are relatively frequent after genotypically non-HLA-identical BMT. We performed univariate analysis to study which BMT-related variables were associated with an increased risk of developing BLPD. Sixty-five recipients of other than genotypically HLA-identical BM grafts were included in the study. Seventy-seven recipients of genotypically HLA-identical BM grafts served as a comparison group. BLPD occurred in nine of 65 children after non-HLA-identical BMT (14%) and in none of the 77 children after HLA-identical BMT (0%). In all cases, BLPD was proven to be EBV-related. Our data suggest that the combined use of Campath 1G and anti-LFA1 was associated with an increased risk of developing BLPD, particularly children who had received a T cell-depleted BM graft, using albumen density gradient sedimentation followed by E-rosetting, and who were conditioned with Ara-C, CY and TBL. In addition, T cell numbers below 50/microliters at 1 month and below 100/microliters at 2 months after BMT, respectively, were associated with an increased risk of developing BLPD. Longitudinal determination of T cell numbers after non-HLA-identical BMT is a simple method for identifying patients at risk of developing BLPD. In addition to monitoring levels of circulating EBV-infected lymphocytes, monitoring T cell numbers may allow early intervention to prevent progression of BLPD.
Gerritsen
E J
EJ
Department of Paediatrics, Leiden University Hospital, The Netherlands.
Stam
E D
ED
Hermans
J
J
van den Berg
H
H
Haraldsson
A
A
van Tol
M J
MJ
van den Bergh
R L
RL
Waaijer
J L
JL
Kroes
A C
AC
Kluin
P M
PM
Vossen
J M
JM
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006566:Herpesviridae Infections / Q000150:complications*; D004854:Herpesvirus 4, Human; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D016393:Lymphoma, B-Cell / Q000209:etiology*; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications*