Abstract
Lymphoproliferative disorders (LPDs) are generally caused by uncontrolled B-cell proliferation induced by the Epstein-Barr virus (EBV) in the setting of impaired EBV-specific T-cell immunity, particularly when there is pharmacological immunosuppression including antithymocyte globulin. We herein present an unusual case of EBV associated with LPD (EBV-LPD) in which LPD occurred 3 weeks after the use of rabbit antithymocyte globulin administered for severe hepatitis-associated aplastic anemia; the patient died of fulminant leukemic lymphoma 5 days after the onset. We also review the pertinent literature on EBV-LPD after immunosuppressive therapy and document the efficacy of EBV viral load monitoring and the need for preemptive therapy.
References
1.
van Esser JW, van der Holt B, Meijer E, Niesters HG, Trenschel R, Thijsen SF, van Loon AM, Frassoni F, Bacigalupo A, Schaefer UW, Osterhaus AD, Gratama JW, Lowenberg B, Verdonck LF, Cornelissen JJ: Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell-depleted SCT. Blood 2001;98:972–978.
2.
Young NS, Calado RT, Scheinberg P: Current concepts in the pathophysiology and treatment of aplastic anemia. Blood 2006;108:2509–2519.
3.
Teramura M, Kimura A, Iwase S, Yonemura Y, Nakao S, Urabe A, Omine M, Mizoguchi H: Treatment of severe aplastic anemia with antithymocyte globulin and cyclosporin A with or without G-CSF in adults: a multicenter randomized study in Japan. Blood 2007;110:1756–1761.
4.
Bacigalupo A: Antilymphocyte/thymocyte globulin for graft versus host disease prophylaxis: efficacy and side effects. Bone Marrow Transplant 2005;35:225–231.
5.
Scheinberg P, Fischer SH, Li L, Nunez O, Wu CO, Sloand EM, Cohen JI, Young NS, John Barrett A: Distinct EBV and CMV reactivation patterns following antibody-based immunosuppressive regimens in patients with severe aplastic anemia. Blood 2007;109:3219–3224.
6.
Wondergem MJ, Stevens SJ, Janssen JJ, Oudejans JJ, Ossenkoppele GJ, Middeldorp JM, Zweegman S: Monitoring of EBV reactivation is justified in patients with aplastic anemia treated with rabbit ATG as a second course of immunosuppression. Blood 2008;111:1739, author reply 1739–1740.
7.
Sillos EM, Shenep JL, Burghen GA, Pui CH, Behm FG, Sandlund JT: Lactic acidosis: a metabolic complication of hematologic malignancies: case report and review of the literature. Cancer 2001;92:2237–2246.
8.
Dorr V, Doolittle G, Woodroof J: First report of a B cell lymphoproliferative disorder arising in a patient treated with immune suppressants for severe aplastic anemia. Am J Hematol 1996;52:108–113.
9.
Sarangi JN, Kashyap R, Choudhry VP, Mishra DK, Saxena R, Gurbaxani S, Bhargava M: Severe aplastic anemia evolving into T cell acute lymphoblastic leukemia. Eur J Haematol 1999;63:269–271.
10.
Takeuchi M, Soda R, Takahashi K, Kimura F, Lai M, Ueda Y: Philadelphia chromosome positive acute lymphocytic leukemia arising from aplastic anemia. Am J Hematol 2000;63:161–162.
11.
Hirose Y, Masaki Y, Ebata K, Okada J, Kim CG, Ogawa N, Wano Y, Sugai S: T-cell type acute lymphoblastic leukemia following cyclosporin A therapy for aplastic anemia. Int J Hematol 2001;73:226–229.
12.
Calistri E, Tiribelli M, Battista M, Michelutti A, Corbellino M, Viale P, Fanin R, Damiani D: Epstein-Barr virus reactivation in a patient treated with anti-thymocyte globulin for severe aplastic anemia. Am J Hematol 2006;81:355–357.
13.
Suzuki Y, Niitsu N, Hayama M, Katayama T, Ishii R, Osaka M, Miyazaki K, Danbara M, Horie R, Yoshida T, Nakamura N, Higashihara M: Lymphoproliferative disorders after immunosuppressive therapy for aplastic anemia: a case report and literature review. Acta Haematol 2009;121:21–26.
14.
Viola GM, Zu Y, Baker KR, Aslam S: Epstein-Barr virus-related lymphoproliferative disorder induced by equine anti-thymocyte globulin therapy. Med Oncol 2011;28:1604–1608.
15.
Aalto SM, Juvonen E, Tarkkanen J, Volin L, Haario H, Ruutu T, Hedman K: Epstein-Barr viral load and disease prediction in a large cohort of allogeneic stem cell transplant recipients. Clin Infect Dis 2007;45:1305–1309.
16.
Wagner HJ, Cheng YC, Huls MH, Gee AP, Kuehnle I, Krance RA, Brenner MK, Rooney CM, Heslop HE: Prompt versus preemptive intervention for EBV lymphoproliferative disease. Blood 2004;103:3979–3981.
17.
van Esser JW, Niesters HG, van der Holt B, Meijer E, Osterhaus AD, Gratama JW, Verdonck LF, Lowenberg B, Cornelissen JJ: Prevention of Epstein-Barr virus-lymphoproliferative disease by molecular monitoring and preemptive rituximab in high-risk patients after allogeneic stem cell transplantation. Blood 2002;99:4364–4369.
18.
Dierksheide JE, Baiocchi RA, Ferketich AK, Roychowdhury S, Pelletier RP, Eisenbeis CF, Caligiuri MA, VanBuskirk AM: IFN-gamma gene polymorphisms associate with development of EBV+ lymphoproliferative disease in hu PBL-SCID mice. Blood 2005;105:1558–1565.
19.
Kojima S, Matsuyama K, Kodera Y, Okada J: Circulating activated suppressor T lymphocytes in hepatitis-associated aplastic anaemia. Br J Haematol 1989;71:147–151.
© 2011 S. Karger AG, Basel
2011
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