[Successful donor lymphocyte infusion for Epstein-Barr virus-associated lymphoproliferative disorder after allogeneic bone marrow transplantation from an HLA 1-locus-mismatched sibling donor in a patient with acute lymphocytic leukemia].
We report a case of Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) after allogeneic bone marrow transplantation (allo-BMT) from a partially mismatched related donor for acute lymphocytic leukemia, which was treated successfully by donor lymphocyte infusion (DLI). A 54-year-old woman in first complete remission from acute lymphocytic leukemia received an unmanipulated bone marrow transplant from an HLA-A 1-locus-mismatched sibling donor after preconditioning with cyclophosphamide and total body irradiation. Prophylaxis against graft-versus-host disease (GVHD) was done with tacrolimus and short-term methotrexate. Skin GVHD (grade I) occurred on day 36, but this subsided spontaneously without treatment. On day 61, rapidly progressive cervical lymphadenopathy with fever developed. Lymph node biopsy revealed lymphoid cell proliferation, which was positive for LCA, L26 and LMP-1. A diagnosis of EBV-LPD was made. After withdrawal of the tacrolimus, DLI (1 x 10(6) CD3 cells/kg) resulted in remission. This case suggests that even in the absence of risk factors such as severe GVHD, intensive immunosuppressive therapy and ATG administration, allo-BMT from an HLA 1-locus-mismatched related donor can be complicated by EBV-LPD, and that reduction of immunosuppressive therapy and DLI can be an effective treatment for it.
Yago
K
K
Department of Internal Medicine, Division of Hematology/Oncology, Shizuoka General Hospital.
Itoh
M
M
Shimada
H
H
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D015234:HLA-A Antigens / Q000276:immunology; D004854:Herpesvirus 4, Human; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D019520:Living Donors; D017710:Lymphocyte Transfusion; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*
D015234:HLA-A Antigens