title: Sustained remission of an extensive monoclonal, Epstein-Barr virus-associated diffuse large B cell lymphoma in a kidney-pancreas transplant recipient.
abstract: BACKGROUND
  Epstein-Barr virus associated posttransplant high-grade large cell lymphoma (EBV-PTL) is thought to be incurable solely by cessation of immunosuppression. We report a case of EBV-PTL resolving rapidly after alleviation of immunosuppression. A strong cytotoxic memory T cell (CTL) reaction against two individual recipient EBV strains appears to be involved.
  
  
  METHODS
  EBV strain identification in donor lymphocytes, tumor cells of EBV-PTL, and circulating lymphocytes of recipient was performed by latent membrane protein 1 fingerprinting.
  
  
  RESULTS
  Stage IIIB EBV-PTL of recipient type was cured through strong autologous CTL reaction consecutive to alleviation of immunosuppression. Latent membrane protein 1 fingerprinting identified three different EBV strains; namely in lymphoma and peripheral lymphocytes of donor and recipient.
  
  
  CONCLUSIONS
  In the setting of solid organ transplantation, rigorous reduction of immunosuppression may lead to cure of high grade EBV-PTL, if the recipient delivers a strong host CTL reaction against the epitopes of EBV latency gene products. Infection with two individual EBV strains earlier in life may increase the number of specific CTL clones and increase the memory capacity.
authors.affiliation: Department of Medicine II, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Markus G
authors.initials: MG
authors.lastname: Manz
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Horny
authors.forename: Robert
authors.initials: R
authors.lastname: Beck
authors.forename: Wolfram
authors.initials: W
authors.lastname: Brugger
authors.forename: Richard
authors.initials: R
authors.lastname: Viebahn
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Hans
authors.initials: H
authors.lastname: Knecht
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004359:Drug Therapy, Combination; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008198:Lymph Nodes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D016035:Pancreas Transplantation; D011183:Postoperative Complications; D012086:Reoperation; D013154:Spleen / Q000821:virology; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents