Iatrogenesis or bad luck? relapse of an LMP1-positive follicular lymphoma after immunosuppression for hepatitis-associated aplastic anaemia.
A 55-year-old man suffered a cutaneous relapse of an LMP1-positive follicular lymphoma after treatment with antithymocyte globulin and cyclosporine A (CSA) for a hepatitis-associated aplastic anaemia (AA). Rituximab was not effective, so CSA was tapered off. Lymphoma masses did not regress but AA relapsed. A second remission of both lymphoma and AA was achieved with high-dose cyclophosphamide, but the patient died of a bilateral pneumonia. The relationships between immunosuppression, viral reactivation and tumour growth are discussed. The use of rituximab and lamivudine in immunodepressed patients is also commented.
Krsnik
Isabel
I
Servicio de Hematología, Hospital Universitario Príncipe de Asturias, Madrid, España. ikrsnik@hupa.insalud.es
García-Suárez
Julio
J
López-Rubio
Montserrat
M
Santana
Alicia
A
D000741:Anemia, Aplastic / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D017809:Fatal Outcome; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000821:virology; D004854:Herpesvirus 4, Human / Q000254:growth & development; D006801:Humans; D007049:Iatrogenic Disease; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D008224:Lymphoma, Follicular / Q000737:chemistry* / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012878:Skin Neoplasms / Q000737:chemistry / Q000473:pathology / Q000821:virology; D014763:Viral Matrix Proteins / Q000032:analysis; D014775:Virus Activation / Q000187:drug effects
D000961:Antilymphocyte Serum; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D014763:Viral Matrix Proteins; D016572:Cyclosporine