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.
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.
Parry-Jones
N
N
Department of Haematology, St George's Hospital, London.
Haque
T
T
Ismail
M
M
Jones
L
L
Hale
G
G
Waldmann
H
H
Gordon-Smith
E C
EC
Crawford
D H
DH
Marsh
J C
JC
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
D006680:HLA Antigens