Heterogeneity in clinical course of EBV-associated lymphoproliferative disorder after allogeneic stem cell transplantation.
OBJECTIVE
Post-transplant lymphoproliferative disorder (PTLD) is a severe complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) associated with Epstein-Barr virus (EBV).


METHODS
Among 263 individuals treated with allo-HSCT for severe aplastic anemia, pure white cell aplasia, T-prolymphocytic leukemia, and relapsed Hodgkin lymphoma, we diagnosed EBV-PTLD in 5 patients. Median age was 29 years (range 19-70 years) and four of five patients were EBV-seropositive prior to HSCT. All five had unrelated EBV-positive donors. In all cases, PTLD occurred within the first year post-transplant (median 4 months).


METHODS
There were two rapidly fatal courses with extensive organ involvement. Both patients showed lymphopenia and thrombocytopenia. In contrast, the three surviving patients had higher lymphocytes and normal platelet counts, while PTLD was restricted to one site and resolved after 2-4 cycles of rituximab.


CONCLUSIONS
In this case series courses of PTLD showed substantial diversity.
Sara C
SC
Meyer
Michael
M
Medinger
Jörg P
JP
Halter
Helen
H
Baldomero
Hans H
HH
Hirsch
Alexandar
A
Tzankov
Stephan
S
Dirnhofer
Jakob R
JR
Passweg
André
A
Tichelli
D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D004854:Herpesvirus 4, Human; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
D000998:Antiviral Agents
Epstein–Barr virus; Hematopoietic stem cell transplantation; Post-transplant lymphoproliferative disorder