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.
Servicio de Hematología, Hospital Universitario Príncipe de Asturias, Madrid, España. ikrsnik@hupa.insalud.es
Isabel
I
Krsnik
Julio
J
García-Suárez
Montserrat
M
López-Rubio
Alicia
A
Santana
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