title: Successful Treatment of Epstein-Barr Virus-Associated Lymphoproliferative Disorder with Rituximab in a Patient Undergoing Immunosuppressive Therapy for Aplastic Anemia.
abstract: Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is a currently emerging serious complication in immunosuppressed patients, especially in allogeneic transplant recipients. Several fatal cases of EBV-LPD have been reported in aplastic anemia (AA) patients receiving immunosuppressive therapy (IST) with antithymocyte globulin (ATG) plus cyclosporine A (CsA), but no appropriate prophylactic or therapeutic strategy has been established. Herein, we describe a 29-year-old man whose EBV-LPD was successfully treated with rituximab. He received IST with ATG plus CsA for hepatitis-associated AA. EBV-DNA in plasma, which was not detectable before IST, gradually increased after IST initiation. A high fever and systemic lymphadenopathy developed 31 days after IST initiation. An EBV-DNA titer of 5.7 × 105 copies/μl was detected, and a diagnosis of EBV-LPD was made. Although discontinuation of IST was not effective, a single dose of rituximab on day 33 resolved the clinical symptoms and completely eliminated EBV-DNA. Even after restarting CsA administration, no elevation of EBV-DNA was observed, and his complete blood cell count had fully recovered 1 year after IST. This case suggests that this treatment strategy for EBV-LPD with EBV-DNA monitoring and rituximab administration, which has been recommended in allogeneic transplant recipients, may also be useful in the context of AA patients receiving IST.
authors: Department of Medicine and Clinical Science, Gunma University, Maebashi, Japan.
authors: Hiroaki
authors: H
authors: Shimizu
authors: Nobuhiko
authors: N
authors: Kobayashi
authors: Masahiro
authors: M
authors: Mihara
authors: Hirono
authors: H
authors: Iriuchishima
authors: Takuma
authors: T
authors: Ishizaki
authors: Yoshihisa
authors: Y
authors: Kojima
authors: Hiroshi
authors: H
authors: Handa
mesh_terms: D000741:Anemia, Aplastic; D020031:Epstein-Barr Virus Infections; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D000069283:Rituximab
chemical_list: D000069283:Rituximab