title: An unexpectedly high incidence of Epstein-Barr virus lymphoproliferative disease after CD34+ selected autologous peripheral blood stem cell transplant in neuroblastoma.
abstract: The risk of Epstein-Barr virus lymphoproliferative disease (EBV-LPD) increases with the use of highly immunosuppressive therapies. Allogeneic BMT, especially supported by T-cell-depleted stem cell products, is a risk factor for EBV-LPD. Although the risk of EBV-LPD after autologous transplantation is low, case reports of this complication in the autologous setting exist. We report a higher incidence than previously described of EBV-LPD in children undergoing sequential high-dose chemotherapy supported with CD34 selected peripheral blood stem cells (CD34+ PBSC). The median time to LPD after tandem transplant was 3 months (range 1-5 months). Five patients out of 156 (3.5%) developed EBV-LPD while enrolled on two trials of tandem autologous SCT in high-risk pediatric malignancies. Both studies employed five cycles of induction therapy, followed by tandem autologous PBSC transplants. In all, 108 out of 156 patients received CD34+ PBSC; 48 received unselected PBSC. All patients contracting LPD were from the CD34 selected group. Treatment of EBV-LPD included rituximab in four out of five patients, i.v.Ig in two out of five patients, and gancyclovir in two out of five patients. EBV-LPD resolved in four out of five patients. We conclude that the combination of tandem SCT and CD34 selection may have increased immunosuppression in these patients to a point where there is an elevated risk of EBV-LPD.
authors.affiliation: Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Powell
authors.forename: N J
authors.initials: NJ
authors.lastname: Bunin
authors.forename: C
authors.initials: C
authors.lastname: Callahan
authors.forename: R
authors.initials: R
authors.lastname: Aplenc
authors.forename: G
authors.initials: G
authors.lastname: Griffin
authors.forename: S A
authors.initials: SA
authors.lastname: Grupp
mesh_terms: D015703:Antigens, CD / Q000097:blood; D018952:Antigens, CD34 / Q000276:immunology; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000821:virology*; D008297:Male; D009447:Neuroblastoma / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D014182:Transplantation, Autologous / Q000009:adverse effects
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34