Posttransplant lymphoproliferative disorder following nonmyeloablative allogeneic stem cell transplantation.
Posttransplantation lymphoproliferative disorder (PTLD) is a well-recognized complication of conventional bone marrow/stem cell and solid organ transplantation. However, not much is known about PTLD following the more recently introduced nonmyeloablative allogeneic stem cell transplantation (NMST). This study reports the findings from two cases of PTLD following NMST and compares them to the one previously reported case. The donor origin of the PTLD was determined using short tandem repeat analysis, and B- and T-cell clonalities were evaluated by polymerase chain reaction. Two cases of PTLD evolved in a total of 70 patients who have undergone NMST at our institution from 1999 to 2003. Both patients received conditioning with Fludarabine/Cytoxan/Campath 1H (alemtuzumab, anti-CD52 antibody) and T-cell-depleted donor cells with Campath-1H. Both PTLDs were EBV positive (by immunohistochemistry and in situ hybridization) with diffuse large B-cell lymphoma morphology. Our findings indicate the incidence of PTLD following NMST is 3% (2 of 70 patients from our institution and 1 of 30 from the previously reported case). All three PTLDs arose 6 to 7 months after NMST and were rapidly fatal. The pathology of the PTLD in all cases was donor origin, EBV positive, diffuse large B-cell lymphoma.
Snyder
Matthew J
MJ
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA. snyde020@mc.duke.edu
Stenzel
Timothy T
TT
Buckley
Patrick J
PJ
Lagoo
Anand S
AS
Rizzieri
David A
DA
Gasparetto
Cristina
C
Vredenburgh
James J
JJ
Chao
Nelson J
NJ
Gong
Jerald Z
JZ
D000328:Adult; D000074323:Alemtuzumab; D000906:Antibodies / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage; D015703:Antigens, CD / Q000276:immunology; D000951:Antigens, Neoplasm / Q000276:immunology; D000074301:CD52 Antigen; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D017403:In Situ Hybridization; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D016133:Polymerase Chain Reaction; D020080:Tandem Repeat Sequences; D019172:Transplantation Conditioning
D000906:Antibodies; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D015703:Antigens, CD; D000951:Antigens, Neoplasm; D000074301:CD52 Antigen; C000613862:CD52 protein, human; D006023:Glycoproteins; D000074323:Alemtuzumab