Summary:
Epstein-Barr virus (EBV) is closely associated with the progressive and often fatal lymphoproliferative disorders (LPD) inBone marrow transplantation provides a life-saving therapy for a variety of hematologic and non-hematologic diseases. 1 In bone marrow transplant recipients, manipulation of the marrow graft, infection, graft-versus-host disease (GVHD), and/or usage of immunosuppressive agents all contribute to delay in immune reconstitution. The incidence of EBV-LPD has been reported to be between 5 and 39% in solid organ transplant recipients. 2-4 EBV-LPD following autologous BMT is rare, 5,6 and the incidence of EBV-LPD in HLA-identical sibling bone marrow transplants is generally less than 1%. 7 Recently, several reports 8-12 have identified risk factors in allogeneic transplants, which are associated with an increased incidence of EBV-LPD. These risk factors include HLA disparity, depletion of the donor marrow graft with T cell-specific monoclonal antibodies (MAb), use of antithymocyte globulin in vivo, and severe GVHD.Increasing numbers of BMT are being performed using alternative donors and manipulated grafts. There has not been much reported focus on the incidence of EBV-LPD on these high-risk patients group. We retrospectively examined EBV-LPD in a series of 318 patients who underwent partially mismatched related donor bone marrow transplants at the Division of Transplantation Medicine in the University of South Carolina. This study represents the largest series describing the incidence of EBV-LPD following PMRD bone marrow transplants with T cell-depleted grafts from a single institution. This descriptive report is focused on EBV-LPD clinical characteristics, relationship
Summary:donor. GVHD prophylaxis consisted of T cell depletion of the donor marrow with T10-B9 (an anti-␣ heterodimer T cell IgM monoclonal antibody), and rabbit complement, We report a patient who developed breast masses 17 months after a T cell-depleted partially mismatched followed by post-BMT immunosuppression with cyclosporine, prednisone, and antithymocyte globulin. Her transplant related donor (PMRD) bone marrow transplant (BMT) for chronic myeloid leukemia. The patient had severe course was uneventful and she had sustained engraftment. On day +155 skin manifestations of chronic GVHD chronic graft-versus-host disease (GVHD) and the masses were due to Epstein-Barr virus (EBV) lymphoappeared after tapering steroid therapy. Immunosuppression with cyclosporine and prednisone was increased and azathiproliferative disease (LPD). The patient expired from fungal pneumonia after chemotherapy for the EBVoprine was added. Azathioprine resulted in leukopenia and the patient discontinued the drug herself. She was main-LPD.
Summary:Graft rejection following bone marrow transplantation is more common in patients who receive their grafts from alternative donors and whose marrow is T cell depleted. Rejection in these patients is mediated by persistent host cells that interfere with successful establishment of donor-derived hematopoietic recovery. We describe a patient with chronic myelogenous leukemia in accelerated phase who rejected a T cell-depleted bone marrow graft, 2 months following partially mismatched related donor bone marrow transplant. Unmanipulated peripheral blood donor leukocyte infusion, without additional chemotherapy or immunosuppressive therapy resulted in complete hematopoietic recovery. Cytogenetics and RFLP demonstrated hematopoietic donor chimerism. The patient did not develop graft-versushost disease. Keywords: bone marrow transplantation; graft rejection; donor leukocyte infusion; partially mismatched related donor; CML Graft rejection following BMT remains a significant problem associated with the use of an alternative donor 1 T cell depletion 2 and the diagnosis of CML. 3 Patients who experience immune-mediated graft rejection have evidence of persistent host cells 4 that interfere with engraftment of the HLA disparate hematopoietic graft. Engraftment of additional donor cells requires ablation of allosensitized host cells. However, treatment to eradicate host cells predisposes the patient to life-threatening infection and additional organ dysfunction. To avoid these complications, we treated graft rejection with donor leukocyte infusion (DLI) alone, and in this report we demonstrate that longterm hematopoietic recovery was established.
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