Epstein-Barr virus-associated B-cell lymphoma secondary to FCD-C therapy in patients with peripheral T-cell lymphoma.
Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorders occur at an increasing frequency in various hereditary and acquired states of immune dysfunction. In a few cases of T-cell lymphoma, especially in angioimmunoblastic T-cell lymphoma (AILT), EBV-associated B-cell lymphoproliferative disorders have been reported. Here, we present two cases of EBV-associated B-cell lymphoma after treatment of T-cell lymphoma (AILT and peripheral T-cell lymphoma, unspecified, PTCL-NOS) with a regimen containing alemtuzumab and fludarabine. Conventional and immunohistological tissue staining showed the typical features of highly proliferating diffuse large B-cell lymphoma in both cases. The monoclonal B-cell population displayed EBV latency type III. At the time of diagnosis the cellular immune status of both patients was severely compromised with an absolute CD4 T-cell count below <120 microl(-1). Our observation supports the notion that combination of cytotoxic drugs and immunosuppressive antibodies in patients with T-cell lymphoma may severely aggravate the already present immunodeficiency. We suggest to monitor the cellular immune status in combination with the EBV load in high risk patients for early detection-and possibly intervention-of EBV-associated lymphoma.
Department of Hematology, Oncology, Immunology, Rheumatology and Pulmology, Medizinische Klinik, Universitäaetsklinik Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany. katja.weisel@med.uni-tuebingen.de.
Katja C
KC
Weisel
Klinik für Onkologie und Hämatologie, Krankenhaus Nordwest, Frankfurt, Germany.
Eckhart
E
Weidmann
Department of Pathology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Ioannis
I
Anagnostopoulos
Department of Hematology, Oncology, Immunology, Rheumatology and Pulmology, Medizinische Klinik, Universitäaetsklinik Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
Lothar
L
Kanz
Department of Hematology/Oncology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
Antonio
A
Pezzutto
Department of Hematology/Oncology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
Marion
M
Subklewe
D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced / Q000473:pathology*; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000139:chemically induced / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000473:pathology; D017735:Virus Latency / Q000187:drug effects
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D003561:Cytarabine; D000074323:Alemtuzumab