Iatrogenesis or bad luck? relapse of an LMP1-positive follicular lymphoma after immunosuppression for hepatitis-associated aplastic anaemia

Acta Haematol. 2002;108(2):90-3. doi: 10.1159/000064743.

Abstract

A 55-year-old man suffered a cutaneous relapse of an LMP1-positive follicular lymphoma after treatment with antithymocyte globulin and cyclosporine A (CSA) for a hepatitis-associated aplastic anaemia (AA). Rituximab was not effective, so CSA was tapered off. Lymphoma masses did not regress but AA relapsed. A second remission of both lymphoma and AA was achieved with high-dose cyclophosphamide, but the patient died of a bilateral pneumonia. The relationships between immunosuppression, viral reactivation and tumour growth are discussed. The use of rituximab and lamivudine in immunodepressed patients is also commented.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Aplastic / drug therapy*
  • Anemia, Aplastic / etiology
  • Anemia, Aplastic / virology
  • Antilymphocyte Serum / administration & dosage
  • Antilymphocyte Serum / adverse effects
  • Cyclosporine / administration & dosage
  • Cyclosporine / adverse effects
  • Fatal Outcome
  • Hepatitis, Viral, Human / complications
  • Hepatitis, Viral, Human / virology
  • Herpesvirus 4, Human / growth & development
  • Humans
  • Iatrogenic Disease*
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppression Therapy / methods
  • Lymphoma, Follicular / chemistry*
  • Lymphoma, Follicular / pathology*
  • Lymphoma, Follicular / virology
  • Male
  • Middle Aged
  • Recurrence
  • Skin Neoplasms / chemistry
  • Skin Neoplasms / pathology
  • Skin Neoplasms / virology
  • Viral Matrix Proteins* / analysis
  • Virus Activation / drug effects

Substances

  • Antilymphocyte Serum
  • EBV-associated membrane antigen, Epstein-Barr virus
  • Viral Matrix Proteins
  • Cyclosporine