title: Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder simultaneously affecting both B and T cells after allogeneic bone marrow transplantation.
abstract: Post-transplantation lymphoproliferative disorder (PTLD) is usually an aberrant proliferation of EBV-infected B cells. We report the case of a 31-year-old man with severe aplastic anemia who suffered PTLD 42 days post-BMT from an unrelated donor. At the onset of PTLD, peripheral blood lymphocytes were comprised of 40% CD20(+) cells, 3% CD4(+) cells, and 56% CD8(+) cells. A highly sensitive in situ hybridization (ISH) method was used to detect EBV-encoded small non-polyadenylated RNA 1 (EBER-1) in 33.9% of sorted CD20(+) cells, 4.4% of CD4(+) cells, and 1.4% of CD8(+) cells. Each T-cell fraction contained less than 0.034% of contaminated EBV-infected B cells. Clonal proliferation of both B and T cells was demonstrated by Southern blotting. The patient did not respond to donor leukocyte infusion and died due to deterioration of PTLD. At autopsy, examination of multiple organs revealed B-cell (rather than T-cell) infiltration. This case clearly indicates that EBV can simultaneously infect B and T cells and can induce clonal proliferation of both lymphocyte subsets in severely immunocompromised patients.
authors.affiliation: Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Japan. tchuhjo@med3.m.kanazawa-u.ac.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Chuhjo
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yachie
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kanegane
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kimura
authors.forename: Shintaro
authors.initials: S
authors.lastname: Shiobara
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakao
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy*; D001402:B-Lymphocytes / Q000473:pathology* / Q000821:virology; D015415:Biomarkers; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology / Q000821:virology; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology / Q000821:virology; D002999:Clone Cells / Q000473:pathology / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D016867:Immunocompromised Host; D017403:In Situ Hybridization; D017708:Leukocyte Transfusion; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000473:pathology / Q000821:virology; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D013601:T-Lymphocytes / Q000473:pathology* / Q000821:virology; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014412:Tumor Virus Infections / Q000150:complications* / Q000473:pathology; D019562:Viral Load; D014766:Viremia / Q000821:virology; D014775:Virus Activation
chemical_list: D015415:Biomarkers; C099537:Epstein-Barr virus encoded RNA 1; D012367:RNA, Viral