title: Unmanipulated donor lymphocytes for EBV-related PTLD after T-cell depleted HLA-haploidentical transplantation.
abstract: Epstein-Barr virus (EBV)-related post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication in patients given T-cell-depleted hematopoietic stem cell transplantation from an HLA-haploidentical relative (haplo-HSCT). We report the case of a child who developed severe EBV-related PTLD after haplo-HSCT from his mother. Despite receiving the anti-CD20 monoclonal antibody, the patient presented with intestinal obstruction due to huge abdominal lymphadenopathy, hematemesis, and nodulary pulmonary lesions. Histology showed that the lesions were due to CD20-/CD19+ large neoplastic B cells. The patient underwent double intestinal resection with partial abdominal lymphadenectomy and then received 3 monthly doses of donor-derived unmanipulated mononuclear cells. The initial dose of CD3+ cells was 3 10(5)/kg recipient body weight. The 2 additional doses consisted of 5 10(5) CD3+ cells/kg. No sign or symptom attributable to graft-versus-host disease was observed, and the patient completely cleared EBV-related lesions. The child was disease-free for 13 months after the first lymphocyte infusion. This case demonstrates that repeated infusions of controlled numbers of donor CD3+ cells cure EBV-related PTLD in haplo-HSCT without inducing graft-versus-host disease.
authors.affiliation: Department of Pediatric Hematology-Oncology, Ospedale Bambino Gesù, Rome, Italy. mdebora.depasquale@opbg.net
authors.forename: Maria Debora
authors.initials: MD
authors.lastname: De Pasquale
authors.forename: Angela
authors.initials: A
authors.lastname: Mastronuzzi
authors.forename: Rita
authors.initials: R
authors.lastname: De Vito
authors.forename: Angela
authors.initials: A
authors.lastname: Cometa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Inserra
authors.forename: Cristina
authors.initials: C
authors.lastname: Russo
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: De Ioris
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D017252:CD3 Complex / Q000032:analysis; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000628:therapy*; D006680:HLA Antigens / Q000032:analysis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008212:Lymphocyte Depletion; D017710:Lymphocyte Transfusion; D008214:Lymphocytes / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000628:therapy* / Q000821:virology; D008297:Male; D000069283:Rituximab; D013601:T-Lymphocytes; D014184:Transplantation, Homologous
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D017252:CD3 Complex; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab