[Post-transplant EBV-associated lymphoproliferative disorders--report of two cases].
We report two cases of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPD) after allogenic bone marrow transplantation which were conditioned with regimens including antithymocyte globulin (ATG). The first case was a 31 year-old man which severe aplastic anemia who was transplanted from HLA-matched unrelated donor conditioned with total lymphoid irradiation (TLI)/ cyclophosphamide/ATG and prophylactic administration of ganciclovir Grade I acute GVHD improved in response to cyclosporine (CsA). LPD as a polyclonal epipharyngeal mass developed at day +53 and spontaneously regressed along with the withdrawal of CsA. Second case was a 11 year-old boy with acute myelomonocytic leukemia (FAB:M4E). He was transplanted from HLA B locus mismatched mother conditioned with total body irradiation (TBI)/busulfan/L-PAM/ATG. He showed grade IV acute GVHD, which was controlled by steroids and FK-506. LPD as a monoclonal intestinal lymphoma was diagnosed at day +82, and he was unsuccessfully treated with ganciclovir, acyclovir, chemotherapy and transfusions of EBV-specific cytotoxic lymphocytes in addition to discontinuation of immunosuppressants, and died at day +18 due to sepsis and multiple cerebral infarction. Early detection and introduction of appropriate treatment for post bone marrow transplantation LPD is necessary.
Iwami
H
H
Department of Pediatrics, Matsushita Memorial Hospital.
Misawa
A
A
Tsunamoto
K
K
Kasubuchi
Y
Y
Naya
M
M
Hojo
M
M
Goto
T
T
Hibi
S
S
Matsumura
T
T
Todo
S
S
Imashuku
S
S
D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D006566:Herpesviridae Infections / Q000150:complications* / Q000635:transmission; D004854:Herpesvirus 4, Human; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015479:Leukemia, Myelomonocytic, Acute / Q000628:therapy; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male