B-cell lymphoproliferative syndrome and peripheral blood CD20+ cells expansion after hematopoietic stem cell transplantation: association with fludarabine and anti-thymocyte globulin containing conditioning regimen.
Fifty-eight patients who received hematopoietic stem cell transplants during a 3-year period in our unit were followed for the symptoms of posttransplant B-cell lymphoproliferative syndrome (B-cell PTLD). Three cases showed lymph node enlargement; in 14, there was an excess of B cells in the blood. Histochemical staining of lymph nodes revealed CD20+ cell expansion in two cases, and in one, CD38+ and CD138+ cells. Kappa and lambda staining revealed poly- or oligoclonal expansion, which was characterized by the presence of Ki67+ cells in 10% to 50% of cells. In 14 cases, an excess of CD20+ cells were observed in blood. Clinical analysis revealed that patients with B-cell expansion in blood and/or in lymph nodes frequently showed fever and that some subjects displayed arthralgia, hemolytic anemia, and hepatitis. LMP-1-positive cells were observed in lymph nodes as well as EBV copies, whereas only a proportion of patients with the excessive CD20+ cells in blood were EBV positive. Notably, lymph node enlargement and CD20+ blood excess occurred significantly more frequently among patients receiving a Fludarabine (Flu) and anti-thymocyte globulin (ATG) conditioning regimen than those whose treatment lacked Flu independent of whether they received ATG (0.80 vs 0.44; P =.036).
Lange
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A
Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigia 12, 53-114 Wrocław, Poland. lange@immuno.iitd.pan.wroc.pl
Klimczak
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Dlubek
D
D
Dybko
J
J
D000328:Adult; D015703:Antigens, CD / Q000097:blood; D018951:Antigens, CD20 / Q000097:blood*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D018655:Lymphocyte Count; D008232:Lymphoproliferative Disorders / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D015703:Antigens, CD; D018951:Antigens, CD20; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine