title: Epstein-Barr virus (EBV) associated B-cell lymphoproliferative disease following HLA identical sibling marrow transplantation for aplastic anaemia in a patient with an EBV seronegative donor.
abstract: BACKGROUND
  B-cell lymphoproliferative disorders (BLPD*) caused by Epstein-Barr virus (EBV) occurring after allogeneic bone marrow transplantation (BMT) are usually of donor origin. Treatment such as discontinuation of immunosuppression may be successful in some cases, but infusion of donor T cells results in successful eradication of EBV BLPD in most cases.
  
  
  RESULTS
  We report a case of EBV positive aggressive BLPD after HLA matched sibling BMT for aplastic anaemia. The tumour completely regressed after withdrawal of cyclosporin and donor lymphocyte infusion. However, although the tumor was of donor origin, the donor serum was negative for antibodies to EBV antigens and no EBV-specific cytotoxicity was detected in donor peripheral blood mononuclear cells. The recipient was seropositive for EBV before BMT.
  
  
  CONCLUSIONS
  We speculate that a 'second primary' EBV infection occurred involving donor cells in the recipient during BMT immunosuppression, with subsequent outgrowth of donor-derived BLPD. EBV infection may have been by an endogenous EBV isolate, from external sources, or from third party transfusions.
authors.affiliation: Department of Haematology, St George's Hospital, London.
authors.forename: N
authors.initials: N
authors.lastname: Parry-Jones
authors.forename: T
authors.initials: T
authors.lastname: Haque
authors.forename: M
authors.initials: M
authors.lastname: Ismail
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.forename: G
authors.initials: G
authors.lastname: Hale
authors.forename: H
authors.initials: H
authors.lastname: Waldmann
authors.forename: E C
authors.initials: EC
authors.lastname: Gordon-Smith
authors.forename: D H
authors.initials: DH
authors.lastname: Crawford
authors.forename: J C
authors.initials: JC
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D001402:B-Lymphocytes / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000276:immunology; D020031:Epstein-Barr Virus Infections / Q000097:blood; D006680:HLA Antigens / Q000097:blood; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000473:pathology* / Q000821:virology*; D008297:Male; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens