EBV-associated post-transplantation B-cell lymphoproliferative disorder following allogenic stem cell transplantation for acute lymphoblastic leukaemia: tumor regression after reduction of immunosuppression - a case report

Abstract

Epstein-Barr virus (EBV)-associated B-cell post-transplantation lymphoproliferative disorder (PTLD) is a severe complication following stem cell transplantation. This is believed to occur as a result of iatrogenic immunosuppression leading to a relaxation of T-cell control of EBV infection and thus allowing viral reactivation and proliferation of EBV-infected B-lymphocytes. In support of this notion, reduction of immunosuppressive therapy may lead to regression of PTLD.We present a case of an 18-year-old male developing a monomorphic B-cell PTLD 2 months after receiving an allogenic stem cell transplant for acute lymphoblastic leukemia. Reduction of immunosuppressive therapy led to regression of lymphadenopathy. Nevertheless, the patient died 3 months afterwards due to extensive graft-vs.-host-disease and sepsis. As a diagnostic lymph node biopsy was performed only after reduction of immunosuppressive therapy, we are able to study the histopathological changes characterizing PTLD regression. We observed extensive apoptosis of blast cells, accompanied by an abundant infiltrate comprising predominantly CD8-positive, Granzyme B-positive T-cells. This observation supports the idea that regression of PTLD is mediated by cytotoxic T-cells and is in keeping with the observation that T-cell depletion, represents a major risk factor for the development of PTLD.

The Effect of Epstein-Barr Virus Latent Membrane Protein 2 Expression on the Kinetics of Early B Cell Infection

“…Previous studies have demonstrated correlations between EBV infection and the development of various lymphomas and carcinomas in both pediatric and adult settings, including Burkitt's lymphoma (BL), Hodgkin's lymphoma (HL) and nasopharyngeal carcinoma (NPC) [1], [2], [3]. In addition, EBV infection is thought to play a critical role in the development of proliferative diseases in immunosuppressed patients, such as post-transplant lymphoproliferative disorder (PTLD), where EBV-transformed B cells proliferate continuously in the absence of an effective T cell response [4], [5].…”

Inhibitory activities of microalgal extracts against Epstein-Barr virus DNA release from lymphoblastoid cells

“…However, EBV infection may lead to the emergence of lymphoproliferative disorders, such as Burkitt's lymphoma (BL) and Hodgkin's lymphoma (HL) and many neoplasms, especially undifferentiated nasopharyngeal carcinoma (NPC) (Rickinson and Kieff, 1996;Rezk and Weiss, 2007). Infection of B lymphocytes by EBV may also cause infectious mononucleosis and posttransplantation lymphoproliferative disorder (PTLD) (Kurth et al, 2000;Krenauer et al, 2010).…”

Inflammation in gastric adenocarcinoma of the cardia: how do EBV infection, Her2 amplification and cancer progression influence tumor-infiltrating lymphocytes?

“…It is thought that some EBV-induced proteins might be involved in a strong T cell response, yet this response is not an effective way of killing EBV-infected cells [18]. However, in EBV-associated B cell post-transplantation disorders, CD8 + cells and Granzyme B + T cells are able to mediate regression [39]. In our study, we could not show the presence of the EBV-encoded latent antigen, LMP1, which was representatively investigated.…”